Pregnancy in patients with multiple sclerosis (MS) requires special care, particularly with regard to decision-making 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 Republic Multiple Sclerosis Patient 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
Background: 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.
Objective: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
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