Neonatal and delivery outcomes in women with multiple sclerosis

Abstract

ObjectiveTo determine (1) whether the risk of adverse neonatal and delivery outcomes differs between mothers with and without multiple sclerosis (MS) and (2) whether risk is differentially associated with clinical factors of MS.MethodsThis retrospective cohort study analyzed data from the British Columbia (BC) MS Clinics' database and the BC Perinatal Database Registry. Comparisons were made between births to women with MS (n = 432) and to a frequency-matched sample of women without MS (n = 2,975) from 1998 to 2009. Outcomes included gestational age, birth weight, assisted vaginal delivery, and Caesarean section. Clinical factors examined included age at MS onset, disease duration, and disability. Multivariate regression models adjusting for confounding factors were built for each outcome.ResultsBabies born to MS mothers did not have a significantly different mean gestational age or birth weight compared to babies born to mothers without MS. MS was not significantly associated with assisted vaginal delivery (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.50–1.16; p = 0.20) or Caesarean section (OR, 0.94; 95% CI, 0.69–1.28; p = 0.69). There was a slightly elevated risk of adverse delivery outcomes among MS mothers with greater levels of disability, although findings were not statistically significant. Disease duration and age at MS onset were not significantly associated with adverse outcomes.InterpretationThis study provides reassurance to MS patients that maternal MS is generally not associated with adverse neonatal and delivery outcomes. However, the suggestion of an increased risk with greater disability warrants further investigation; these women may require closer monitoring during pregnancy. ANN NEUROL 2011;

Birth hospitalization in mothers with multiple sclerosis and their newborns

“…[3][4][5][6] Although not all agree, more recent studies found no link between MS and adverse perinatal outcomes. [7][8][9][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.…”

“…This cohort of mothers and newborns has been described previously. 7 Briefly, births were classified as "births to MS mothers" if women had a neurologist-confirmed diagnosis of laboratory-supported or clinically definite MS (Poser 16 or McDonald 17 criteria) with disease onset before delivery. Birth hospitalization data of MS mothers were obtained by linking the BCMS database to the BCPDR at the individual level via the Personal Health Number, a unique identifier assigned to all residents of BC, verified by maternal names and dates of birth.…”

“…In this cohort, women with MS had 1 stillbirth whereas the sample of women in the general population had 16 stillbirths. The cohort characteristics have been previously reported 7 and are summarized in table 1. Women in the MS group were more likely to be first-time mothers, hypertensive, nondiabetic, to smoke cigarettes during pregnancy, have a higher BMI, attend more antenatal visits, and have a longer duration of the second stage of labor.…”

“…Consistent with this was the observation of an increased risk of cesarean deliveries, a known cause of longer birth hospitalizations, 19,20 in women with MS when MS was identified by ICD billing codes alone 4 -something not found in other studies with a more comprehensive case ascertainment. 7 One study examining hospital stays in newborns of mothers with MS 11 reported longer stays (relative risk 5 1.5; 95% CI: 0.99-2.3) compared with newborns of mothers without MS 11 ; however, the authors speculated this was attributable to the common practice of discharging mother and newborn home together, as no other adverse birth outcomes were observed. Our study differed from previous studies 4,11 examining birth hospitalizations in a number of ways: first, our study included a cohort of women with clinically definite MS confirmed by an MS specialist neurologist, rather than relying on a single ICD code (a valid algorithm for MS requires multiple ICD billing codes recorded over a period of time) 23 to identify MS. Second, we found that the length of birth hospitalization in patients with MS was not associated with disease duration or level of disability, which was not previously examined.…”

Obstetric anesthesia/analgesia does not affect disease course in multiple sclerosis: 10‐year retrospective cohort study

“…Multiple sclerosis often manifests in early adulthood (Compston & Coles, 2002) with an average onset age of 32 years, (Shirani, Zhao, Kingwell, Rieckmann, & Tremlett, 2012) making pregnancy issues of real importance in women with MS. Studies have shown that between 1/5 and 1/3 of women with MS bear children after disease onset, (Runmarker & Andersen, 1995; Weinshenker, Hader, Carriere, Baskerville, & Ebers, 1989) making the effect of maternal MS on pregnancy outcomes relevant to patients, their family members, and health care professionals (van der Kop et al., 2011). In the past, pregnancy was discouraged in women with MS; however recent studies have shown pregnancy as having a potentially beneficial role on MS relapse rates with no effects on long‐term progression of the disease (Confavreux, Hutchinson, Hours, Cortinovis‐Tourniaire, & Moreau, 1998; Koch, Uyttenboogaart, Heersema, Steen, & De Keyser, 2009; Vukusic et al., 2004).…”