Deakin University

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Predictors and dynamics of postpartum relapses in women with multiple sclerosis

journal contribution
posted on 2014-05-01, 00:00 authored by S E Hughes, T Spelman, O M Gray, C Boz, M Trojano, A Lugaresi, G Izquierdo, P Duquette, M Girard, F Grand'Maison, P Grammond, C Oreja-Guevara, R Hupperts, R Bergamaschi, G Giuliani, J Lechner-Scott, M Barnett, M Edite Rio, V van Pesch, Cameron ShawCameron Shaw
BACKGROUND: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies. OBJECTIVE: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse. METHODS: An observational case-control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses. RESULTS: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model. CONCLUSION: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.



Multiple sclerosis journal






739 - 746




London, Eng.





Publication classification

C Journal article; C1.1 Refereed article in a scholarly journal