Pregnancy and multiple sclerosis –outcomes analysis 2003–2011

Česká verzia

Authors: P. Hanulíková ¹; R. Vlk ¹; E. Meluzínová ²; E. Hynčicová ²; T. Binder ¹; R. Chmel ¹ ; Lukáš Rob ¹
Authors place of work: Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha, přednosta prof. MUDr. L. Rob, CSc. ¹; Neurologická klinika 2. LF UK a FN Motol, Praha, přednosta doc. MUDr. M. Bojar, CSc. ²
Published in the journal: Ceska Gynekol 2013; 78(2): 142-148

Summary

Objective:
The analysis of perinatal results in pregnant women with multiple sclerosis (MS) and the assessment of the influence of pregnancy on this chronic disease in the population of pregnant women in our hospital in the years 2003–2011.

Design:
Retrospective analysis.

Setting:
Department of Obstetrics and Gynecology and Department of Neurology, 2^nd Faculty of Medicine, Charles University and the Motol Hospital, Prague.

Methods:
Sixty-six women with the diagnosis of MS were included in our study in the years 2003–2011. All these women delivered at our clinic and were neurologically followed until the end of six months post partum.

We evaluated the influence of pregnancy on the activity of the disease during the pregnancy and 6 months after delivery, the impact on the disability progression, the influence of the mode of delivery, the analgesia used, and breastfeeding, on the relapse rate post partum. We also assessed the impact of multiple sclerosis on the course of the pregnancy, where we looked for pregnancy complications in patients with multpile sclerosis, differences in the management of labor, and the results of newborns of mothers with this disease. We performed a statistical analysis.

Results:
Relapse during pregnancy occurred in4 of the 66 women (6.1%, relapse rate – RR 0.1);17 women experienced a post partum relapse in the first six months after delivery (25.7%, RR 0.5). From our sample of 44 women breastfed (66.7%), 10 had relapse (10/44, 22.7%) in comparison with the 7 women out of a total of 22 who did not breastfed (7/22, 31.8%). No statistical significance was established, OR = 0.6 (0.2–2.0), p = 0.5518. Epidural analgesia (EDA) was used by 16 women (24.2%). Post partum relapse experienced 3 women that used EDA (3/16, 18.8%) and 14 women that did not use EDA (14/50, 28 %). OR = 0.6 (0.1–2.4), p = 0.5325. Neither breastfeeding, nor epidural analgesia correlated with presence of a post partum relapse. Pregnancy did not influence disability progression, EDSS (Disability status scale, Kurtzke`s scale) before pregnancy and after delivery was stable (EDSS 1.5 or EDSS 1.6). Vaginal delivery had 77% women, post partum relapse had 15 of them (15/50, 30%), 12 women (18.1%) had a caesarean sec-tion, relapse occure at 2 of them (2/16, 12.5%), three births (4.5%) were completed by vaginal extraction operations.

Five women (7.6%) delivered before 37^th week of pregnancy. Birth weight under 2500 g was found in 9 women (13.6%). The incidence of serious pregnancy complications was not increased, intrauterine growth retardation (IUGR) was confirmed in 4 births (6%).

Conclusion:
There is no need to worry about pregnancy in patients with multiple sclerosis. Therapy provides long-term remission of the disease, and during pregnancy itself due to hormonal changes it is stabilized and the relapse rate decreases. In the post partum period relapse rate increases, however, the pregnancy did not influence disability progression. The mode of delivery in women with this disease is not different from the general population. Neither breastfeeding, nor epidural analgesia correlated with presence of a post partum relapses. The number of complications in pregnancy is not increased and the overall perinatal outcomes are comparable with the general population.

Keywords:
multiple sclerosis – relapse rate – pregnancy – perinatal outcomes

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