Multiple sclerosis and related disorders · 2026
Pregnancy outcomes in patients with multiple sclerosis with or without exposure to disease-modifying treatment: A retrospective cohort study on Iranian population.
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Paybast Sepideh, Asl Fallah Elham, Sahraian Mohammad Ali, Azimi Amir Reza
Аннотация
INTRODUCTION: Multiple sclerosis (MS) is often diagnosed in women of childbearing age. While MS does not negatively influence most pregnancy outcomes, there is a lack of data on Iranian patients. The present study aimed to reveal our experience with pregnancy outcomes in MS women.
MATERIAL AND METHODS: This retrospective cohort was conducted between January 2016 and February 2023 at the MS Clinic of Sina and Imam Hossein Hospital. One hundred seventy-eight patients with a history of pregnancy were enrolled. Patients' demographics, MS characteristics, and pregnancy-related outcomes were collected from their reports. Eventually, statistical analysis was carried out by using SPSS 26.0.
RESULTS: 178 patients with a mean age of 32.24 ± 5.02 years, a mean disease duration of 6.17 ± 4.26 years, and a median Expanded Disability Status Scale (EDSS) of 1.00 ± 1.38 were enrolled. 94.4% of patients were classified as relapse-remitting MS (RRMS), mainly treated with low to moderate efficacy disease-modifying treatment (DMT). We identified an incidence rate of 3.4% for spontaneous abortion and 1.7% for stillbirth, which was not affected by the fetus's exposure to DMTs (P = 0.99). The results revealed a significant increase in the relapse rate within the first six months after childbirth (12.4%vs 2.2%) (P = 0.009), followed by a subsequent decline (3.4%) over the next six months (P = 0.06), leading to a comparable rate in a year before pregnancy (P = 0.44). The clinical relapse a year before pregnancy was the only risk factor to develop early postpartum relapse (p = 0.02). Moreover, patients treated with high-efficacy DMTs were less likely to develop early postpartum relapse (P = 0.02).
CONCLUSION: Our preliminary results suggest that DMT exposure before or during pregnancy does not adversely increase the rate of congenital anomalies or spontaneous abortions. Most patients were stable during and in a year after pregnancy. Moreover, the pre-pregnancy use of high-efficacy DMTs might decrease the risk of postpartum relapse.
MATERIAL AND METHODS: This retrospective cohort was conducted between January 2016 and February 2023 at the MS Clinic of Sina and Imam Hossein Hospital. One hundred seventy-eight patients with a history of pregnancy were enrolled. Patients' demographics, MS characteristics, and pregnancy-related outcomes were collected from their reports. Eventually, statistical analysis was carried out by using SPSS 26.0.
RESULTS: 178 patients with a mean age of 32.24 ± 5.02 years, a mean disease duration of 6.17 ± 4.26 years, and a median Expanded Disability Status Scale (EDSS) of 1.00 ± 1.38 were enrolled. 94.4% of patients were classified as relapse-remitting MS (RRMS), mainly treated with low to moderate efficacy disease-modifying treatment (DMT). We identified an incidence rate of 3.4% for spontaneous abortion and 1.7% for stillbirth, which was not affected by the fetus's exposure to DMTs (P = 0.99). The results revealed a significant increase in the relapse rate within the first six months after childbirth (12.4%vs 2.2%) (P = 0.009), followed by a subsequent decline (3.4%) over the next six months (P = 0.06), leading to a comparable rate in a year before pregnancy (P = 0.44). The clinical relapse a year before pregnancy was the only risk factor to develop early postpartum relapse (p = 0.02). Moreover, patients treated with high-efficacy DMTs were less likely to develop early postpartum relapse (P = 0.02).
CONCLUSION: Our preliminary results suggest that DMT exposure before or during pregnancy does not adversely increase the rate of congenital anomalies or spontaneous abortions. Most patients were stable during and in a year after pregnancy. Moreover, the pre-pregnancy use of high-efficacy DMTs might decrease the risk of postpartum relapse.