MRI activity in MS and completed pregnancy

Abstract

ObjectiveTo evaluate postpartum MRI activity in patients with MS and a completed pregnancy and to compare these results to an age-matched untreated nonpregnant MS cohort.MethodsPatient with MS from a tertiary care MS center between 2006 and 2015, with prepartum and postpartum neurologic follow-ups and MRI scans were analyzed. Clinical activity and inflammatory brain MRI activity (new T2-hyperintense or gadolinium-enhancing [Gd+] lesions) were assessed peripartum. The results were compared with untreated reproductive-age patients with MS from the placebo arm of the clinical trials.ResultsA total of 123 pregnancies in 123 women (median Expanded Disability Status Scale 1.0) were analyzed. Approximately 7.2% relapsed during pregnancy and 48.7% relapsed postpartum. Of pregnancies with prepartum and postpartum gadolinium (Gd)-enhanced MRI (n = 112), 8% had Gd+ lesions prepartum and 33% had new Gd+ lesions postpartum. Overall, 54.4% had either new T2 or Gd+ lesions postpartum. Seventy-nine percent of subjects with postpartum relapse had new MRI activity compared with 37.1% without relapse (p < 0.001). Twenty-five percent had both clinical and radiographic activity and only 24.9% maintained no evidence of disease activity status postpartum. There was no association between postpartum MRI activity and disease-modifying treatments (DMTs) (p > 0.5). MRI and clinical outcomes were also assessed for 126 nonpregnant untreated female patients with MS. Comparing pregnancy and no pregnancy groups, there was no difference in MRI activity at follow-up.ConclusionsThere was a high level of inflammatory radiographic disease activity which was related to relapses in postpartum patients with MS. Further studies are needed to determine whether hormonal fluctuations vs extended time off DMTs may be the underlying cause of our observations.

Thalamus Atrophy in the Peri-Pregnancy Period in Clinically Stable Multiple Sclerosis Patients: Preliminary Results

“…However, classical MRI activity on post-partum scans was detected in most of our patients. Our finding concerning new GD+ and new T2 lesions in the post-partum period is consistent with previously published studies [1][2][3][4]. We are aware that the classical MRI activity observed in our patients may be related to the discontinuation of DMT, but on the other hand, the results from published research are not consistent regarding this issue [3,4,21].…”

“…Magnetic resonance imaging (MRI) activity (new gadolinium-enhanced lesions (Gd+) and new/enlarged T2-weigheted lesions) in the post-partum period in multiple sclerosis (MS) patients has been demonstrated in a few published studies [1][2][3][4]. However, the impact of pregnancy on gray and white matter atrophy in MS is not well-characterized.…”

Drug and Neurofilament Levels in Serum and Breastmilk of Women With Multiple Sclerosis Exposed to Natalizumab During Pregnancy and Lactation

“…Disease reactivation following NAT cessation prior to or during pregnancy is well recognized and can lead to the accumulation of permanent disability ( 6 , 39 – 41 ). Even the postpartum period entails an increased relapse risk and could be linked to a high level of inflammatory radiographic disease activity as it was shown in a recent study ( 3 , 4 , 11 , 42 ). None of our patients who received NAT prior to, across and after pregnancy or who started treatment due to a relapse in the second trimester suffered from a (further) relapse during gestation or in the first six months postpartum.…”

Magnetic Resonance Imaging (MRI) Safety in Pregnant (A Literature Review)

“…The disadvantages of using MRI are the dangers of pulsed electromagnetic gradient fields that cause biological effects, acoustic noise damage, peripheral nerve stimulation (twitching sensation arising from the process inside the MRI machine), peripheral muscle stimulation, cardiac fibrillation, and magneto phosphenes, miscarriage and heating effects (Houtchens et al 2020). Noise occurs due to the rapid alternation of currents within the gradient coils.…”