Birth hospitalization in mothers with multiple sclerosis and their newborns

Abstract

Objective: To compare the duration of birth hospitalization in mothers with multiple sclerosis (MS) and their newborns relative to the general population and to investigate the impact of MS-related clinical factors on the length of birth hospitalization stays.Methods: Data from the British Columbia Perinatal Database Registry and the British Columbia MS database were linked in this retrospective cohort study. The duration of birth hospitalization in mothers with MS and their newborns (n 5 432) were compared with a frequency-matched sample of the general population (n 5 2,975) from 1998 to 2009. Clinical factors investigated included disease duration and disability, as measured by the Expanded Disability Status Scale. A multivariable model (generalized estimating equations) was used to analyze the association between MS and duration of birth hospitalization, adjusting for factors such as maternal age, diabetes, hypertension, and consecutive births to the same mother. Additional analyses included propensity score matching to further balance cohort characteristics.Results: Compared with the general population, the duration of birth hospitalization was not statistically or clinically different for mothers with MS or their newborns (median differences 5 11.5 and 12.1 hours, respectively; adjusted p . 0.4). Lengths of birth hospitalization were not significantly associated with disease duration (adjusted p . 0.7) or level of disability (adjusted p . 0.5). Findings remained virtually unchanged after propensity score matching.Conclusions: Birth hospitalization has been understudied in women with MS. Contrary to existing studies, we found that MS was not associated with a longer birth hospitalization. This study provides assurance to expectant mothers with MS, their families, and health care providers. Multiple sclerosis (MS) is a chronic degenerative disease of the CNS, often manifesting in women of childbearing age. 1 Fatigue and pelvic organ dysfunction are common, 2 which may cause difficult labor and prolonged birth hospitalization. MS has been associated with a greater risk of difficult labor, 3 assisted vaginal delivery, 3 cesarean delivery, 4 as well as impaired fetal growth and prematurity. [3][4][5][6] Although not all agree, more recent studies found no link between MS and adverse perinatal outcomes. 7-10 However, the durations of birth hospitalization were not examined in these studies. To our knowledge, only 2 studies have examined birth hospitalization in MS 4,11 ; both were from the United States and reported longer hospital stays for mothers with MS 4,11 and their newborns 11 compared with the general population. Prolonged stays can have negative consequences, including an increased risk of hospital-acquired infection as well as creating a strain on scarce health care resources. 12 By linking 2 comprehensive population databases, the British Columbia Multiple Sclerosis (BCMS) database and the British Columbia Perinatal Database Registry (BCPDR), we

Definitive childlessness in women with multiple sclerosis: a multicenter study

“…Women with MS do not seem to have a higher risk of obstetrical/neonatal complications [10,11,25], although there are some contrasting reports [2,8], and they may undergo planned CDs more frequently compared to the general population, [10] especially if they have a higher disability [11]. The diagnosis of MS alone, should not lead to the decision of a CD, which should be considered should there be concern about spasticity, neuromuscular perineal weakness or exhaustion.…”

Pregnancy, sex and hormonal factors in multiple sclerosis

“…81–83 A trend for more frequent labor induction in women with greater disability warrants further investigation. 82 Neither epidural anesthesia 84,85 nor cesarean section 85 has been associated with adverse effects on delivery or postpartum MS course.…”

Exploring Patients’ Knowledge and Misconceptions about Multiple Sclerosis and Pregnancy

“…While some studies have shown a higher rate of assisted vaginal deliveries, for example requiring induction and slower progression of labor, 5 there is evidence to suggest that mothers and newborns do equally well and do not have longer birth hospitalizations that non-MS counterparts, even when accounting for longer disease duration and increased disability. 15 Our study has several limitations. As a single-center pilot study conducted in an urban area, our results might not be broadly generalizable to the MS population.…”