Pregnancy outcomes in Portuguese women with multiple sclerosis: The PREGNIMS study

Abstract

Introduction: Several questions about pregnancy in women with multiple sclerosis (MS) have been discussed, but clarification is still needed in some very practical issues. Portuguese data on this subject remain scattered and need to be analyzed in order to standardize clinical practice. Objective: This study aimed to describe and analyze the impact of MS on pregnancy and perinatal health of children born to Portuguese mothers with the disease. Material and methods: This is a multicenter, retrospective study of a cohort of Portuguese women with MS who were pregnant and who gave birth between 01/01/2011 and 31/12/2015. Demographic and clinical data related to maternal disease, pregnancy progression and events, childbirth and newborn health were collected. Results: Ninety-seven women were recruited and 90 live births were evaluated. The mean maternal age at conception was 32.5 years, and 63.9% had no relapses in the previous year (98.0% had a relapsing-remitting MS and the EDSS score was ≤ 3 in 92.8% of the cases). Only 50.5% of the women had a preconception specific evaluation and 60 children were exposed to immunomodulatory therapies during pregnancy. Nineteen women had relapses during pregnancy. Childbirth was induced in 22.7% of the cases, and the caesarean section rate was 34%. Children exposed to immunomodulatory drugs during pregnancy had a lower birth length (p = 0.014), and there was also a trend toward lower birth weight (p = 0.054) in these newborns. Pre-conception EDSS score negatively correlated with the duration of pregnancy (r = -0.22; p = 0.029), weight (r = -0.23; p = 0.031) and cephalic perimeter at birth (r = -0.24; p = 0.033). There was no relationship between the occurrence of relapses or progression in EDSS score during pregnancy with any variables related to the newborn. Conclusions: In our cohort, it has been confirmed that MS has no negative effect on pregnancy or on children's perinatal health. However, the use of immunomodulatory drugs may have some impact on newborns' somatometric features.

Cesarean section in women with MS: A choice or a need?

“…Of particular relevance, we found a lower gestational age and a lower birth weight in all sample of patients with MS. Some authors discuss a reduced (but still in the normal range) birth weight for newborns of mothers with MS, compared to healthy controls [4][5][6][7][8][9]. Our data support this observations.…”

Pregnancy in multiple sclerosis: A reflection on the importance of individualizing management

“…Since the classical PRIMS publication, 1 several studies have demonstrated lower multiple sclerosis (MS) relapse rates during pregnancy, particularly during the third trimester. Hence, contrary to past beliefs, it has been now accepted that pregnancy does not interfere negatively in the course of the disease 1‐4 …”

The Potential Preventive Effect of Pregnancy and Breastfeeding on Multiple Sclerosis

“…Although the course of MS is highly unpredictable, disease activity in pregnancy is lower than in the prepregnancy period [16][17][18][19][20][21][22][23][24][25]. A beneficial effect of pregnancy on disease progression has been found by some researchers, whereas others found that parity was not related to secondary disease progression [16,26].…”