Multiple sclerosis and pregnancy: A single-centre prospective comparative study

• Published in: Neurología (Barcelona, English ed. ) Vol. 32; no. 2; pp. 92 - 98
• Main Authors: Cuello, J.P., Martínez Ginés, M.L., Martin Barriga, M.L., de Andrés, C.
• Format: Journal Article
• Language: English
• Published: Elsevier España, S.L.U 01.03.2017; Elsevier España
• Subjects: Artificial insemination; Breastfeeding; Embarazo; Esclerosis múltiple; Fecundación in vitro; Immunomodulatory therapy; In vitro fertilisation; Inseminación artificial; Lactancia; Multiple sclerosis; Pregnancy; Terapia inmunomoduladora; Pregnancy; Lactancia; Inseminación artificial; Multiple sclerosis; Embarazo; Artificial insemination; Fecundación in vitro; Immunomodulatory therapy; In vitro fertilisation; Breastfeeding; Esclerosis múltiple; Terapia inmunomoduladora
• ISSN: 2173-5808; 2173-5808
• DOI: 10.1016/j.nrleng.2014.12.020

Multiple sclerosis (MS) is a autoimmune disorder which preferentially affects young women of childbearing age. During pregnancy, the annualised relapse rate (AAR) is modified, but pregnancy has no harm effect on the long-term course of the disease. We aimed to study the clinical course of our MS patients during pregnancy, and compare their obstetrics outcomes with a control group of non-MS patients. A single centre prospective observational study was conducted. We assessed the reproductive history, MS history, pregnancy course and new-born outcome of a cohort of MS patients who had had a pregnancy between January 2007 and July 2012. We compared the global outcomes with a control cohort of 58 age-matched healthy pregnancies. Complete data from 35 consecutive women were analysed, 40 deliveries. Control groups: 58 patients, 60 deliveries. EDSS at pregnancy 0.7. ARR before pregnancy 0.5. During pregnancy 0.3, after pregnancy 0.4. Twelve patients were on disease-modifying drugs (DMD) before pregnancy, 4 prenatal exposure occurs. The comparison between relapse rate and EDSS before, during and after delivery showed no statistically significant difference. In addition, compared to control group, there were also no differences in the obstetric outcomes. In MS cohort, we found a higher incidence of assisted reproductive treatments and lower breastfeeding rate, both statistically significant. Our series confirms that pregnancy has no negative long term impact on the progression of MS and also suggest that there is no additional morbidity in the pregnancy, comparing to the rest of the population. La esclerosis múltiple (EM) es una enfermedad autoinmune que afecta preferentemente a mujeres en edad fértil. Durante el embarazo y puerperio, cambia la tasa anual de brotes (TAB) de EM, sin modificar la evolución a largo plazo. Analizamos la repercusión del embarazo en pacientes con EM, y comparamos sus resultados obstétricos con embarazos de mujeres sanas. Estudio unicéntrico, observacional descriptivo, de diseño longitudinal prospectivo. Se analizan los datos globales de una cohorte de pacientes con EM que han dado a luz entre enero de 2007 y julio de 2012, con un seguimiento de 2 años posparto. Los resultados obstétricos se compararon con un grupo control de 58 embarazadas sanas, elegidas al azar de nuestro centro durante el mismo período de tiempo. Un total de 35 pacientes con EM, 40 partos. Grupo control: 58 mujeres, 60 partos. EDSS preembarazo: 0,7. TAB 2 años preembarazo: 0,5. Durante el embarazo: 0,3, a los 2 años posparto: 0,4. Doce pacientes recibían FME previo al embarazo, 4 iniciaron la gestación con FME. No hubo diferencias estadísticamente significativas en la TAB ni en la EDSS entre períodos preembarazo, embarazo y posparto. Al comparar con grupo control, no hubo diferencias en edad materna, semanas de gestación, peso al nacer, porcentaje de cesáreas, ni complicaciones obstétricas. En pacientes con EM hubo mayor porcentaje de tratamientos por infertilidad y menor porcentaje de lactancia, ambos estadísticamente significativos. Nuestro trabajo confirma que el embarazo no repercute negativamente en el curso de la EM y que no existe mayor morbilidad obstétrica comparado con mujeres sanas.