Pregnancy in patients with multiple sclerosis (MS) requires special care, particularly with regard to decisions regarding disease-modifying disease (DMD) treatment and counselling regarding the period of conception, pregnancy and the postpartum period. This study aims to analyse the impact of pregnancy, childbirth or miscarriage on the course of multiple sclerosis in women with MS in the Czech Republic. The analysis was based on retrospective data from the Czech national registry ReMuS and includes data on 1 533 pregnancies. The results provide valuable insights into the safety of pregnancy for women with MS and how pregnancy and the postpartum period affect the course of the disease.
Pavel Hradílek, MD, PH.D.
University Hospital Ostrava
Hradilek, P., Meluzinova, E., Zapletalova, O., Hanulikova, P., Horakova, D., Woznicova, I., Pavliska, L., Stetkarova, I., Valis, M., Stourac, P., Adamkova, J., Ampapa, R., Vachova, M., & Mares, J. (2022). Is pregnancy in MS patients safe and what is its impact on MS course? Real World evidence of 1533 pregnancies in Czech Republic. In Multiple Sclerosis and Related Disorders (Vol. 59, p. 103391). Elsevier BV. https://doi.org/10.1016/j.msard.2021.103391 PMID: 35240415
Abstract
Introduction: Special care for women with multiple sclerosis (MS) who are planning a pregnancy is very challenging, especially when it comes to making decisions regarding disease-modifying treatment (DMD) and counselling regarding the conception, pregnancy and postpartum period.
Target: To provide data on the impact of pregnancy, childbirth or miscarriage/abortion on the course of MS in Czech women with MS based on analysis of retrospective data from the Czech national ReMuS registry.
Methods: The analysis focused on women with MS who had at least one pregnancy record in the registry. Clinical data (EDSS, relapses) were collected before conception, during pregnancy and after delivery or miscarriage/artificial termination of pregnancy. These data were analyzed by baseline characteristics of DMD treatment before conception and by breastfeeding status.
Results: A total of 1,533 pregnancies from 2013 to 31 December 2019 were analyzed. The incidence of relapses and worsening EDSS was significantly associated with treatment with escalation therapy before conception. Relapses were significantly more common in women who breastfed for less than 3 months than in women who breastfed for more than 3 months or did not breastfeed at all. Patients who were treated with fingolimod or natalizumab before pregnancy were significantly more likely to have relapses during pregnancy.
Conclusion: Pregnancy and the postpartum period were generally safe for Czech women with MS. Better outcomes were observed in those who were treated with first-line injectable DMDs before conception and in those who breastfed for more than 3 months or did not breastfeed at all. We confirmed the assumption of an MS rebound phenomenon after treatment discontinuation due to planned pregnancy, both for fingolimod and natalizumab.
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