Is pregnancy in MS patients safe and what is its impact on MS course? Real World evidence of 1533 pregnancies in Czech Republic

• Published in: Multiple sclerosis and related disorders Vol. 59; p. 103391
• Main Authors: Hradilek, Pavel, Meluzinova, Eva, Zapletalova, Olga, Hanulikova, Petra, Horakova, Dana, Woznicova, Ivana, Pavliska, Lubomir, Stetkarova, Ivana, Valis, Martin, Stourac, Pavel, Adamkova, Jana, Ampapa, Radek, Vachova, Marta, Mares, Jan
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2022
• Subjects: Czech national registry ReMuS; Czech Republic - epidemiology; EDSS; Female; Fingolimod Hydrochloride - therapeutic use; Humans; Multiple sclerosis; Multiple Sclerosis - chemically induced; Multiple Sclerosis - drug therapy; Multiple Sclerosis - epidemiology; Natalizumab - therapeutic use; Pregnancy; Relapses; Retrospective Studies; Czech Republic; Pregnancy; Czech national registry ReMuS; Multiple sclerosis; Relapses; EDSS
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2021.103391

•This article brings original data describing MS disease activity parameters during pregnancy, postpartum period or associated with abortion in the population of Czech women with MS.•These data are evaluated according to disease progression (EDSS), and relapses during these periods.•These parameters are correlated to the type of treatment, periods of pregnancy or postpartum period or breastfeeding.•We conclude that pregnancy is generally safe in the population of Czech women, however we have to treat these patients with more care during certain situations regarding type of treatment or period of pregnancy or postpartum. A special care of MS women planning a pregnancy is highly demanding especially in the terms of disease modifying treatment (DMD) decisions and counselling regarding periods of conception, pregnancy and postpartum period. To provide data about impact of pregnancy, delivery or miscarriage/artificial abortion on MS disease course in Czech women with MS based on analysis of retrospective data from the Czech national registry ReMuS. The analysis focused on women with MS with at least one record of pregnancy in the registry. Clinical data (EDSS, relapses) were collected prior to conception, during pregnancy and after delivery or miscarriage/artificial abortion. These data were analysed according to baseline characteristics of DMD treatment prior to conception and according to breastfeeding status. A total of 1 533 pregnancies were analysed from the period of 2013 until 31st December 2019. The occurrence of relapses and worse EDSS was significantly related to the treatment with escalation therapy prior to conception. Relapses were significantly more frequent in women who breastfed less than 3 months than in women who breastfed more than 3 months or did not breastfeed at all. Patients treated with either fingolimod or natalizumab prior to pregnancy were significantly more likely to develop relapses during pregnancy. Pregnancy and postpartum period were generally safe for Czech women with MS. Better disease outcomes were observed in those who had been treated with first line injectable DMDs prior to conception and those who either breastfed more than 3 months or did not breastfeed at all. We confirmed the assumption of rebound phenomenon of MS after discontinuation of treatment due to planned pregnancy both for fingolimod and natalizumab.