Pregnancy in women with MS relapses in the year before conception increases the risk of disability

Women with multiple sclerosis (MS) who had a relapse in the year before pregnancy were associated with an increased risk of disability worsening, according to a study published in the Multiple Sclerosis Journal.

Researchers at the University of Florence obtained data from the Italian pregnancy record, which was collected in 21 locations across Italy. Women with MS who were pregnant between 2002 and 2008 were compared to women who were not pregnant. The study researchers collected data for the control group at the MS center in Florence. They then assessed the clinical outcomes over an average of 6.5 years.

The pregnancy (n = 230) and control cohorts (n = 102) comprised women with an average age of 32.4 and 33.4 years, an illness duration at the start of the study of 6.9 and 6.7 years, and an extended disability status scale (EDSS) from 1.4 and 1.5. respectively.

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More women who were not pregnant took disease-modifying drugs for long periods of time (46.1% and 15.7%, respectively; P <0.001).

The study researchers observed that disability progressed in 28.3% of the pregnancy group and 21.6% of the control cohort (P = .201).

The risk of disability progression was associated with a relapse in the year before conception (adjusted hazard ratio [aHR], 1.74; 95% CI 1.06-2.84; P = 0.027), higher baseline EDSS (aHR 1.39; 95% CI 1.12-1.74; P = 0.003) younger age at baseline (aHR 0.95; 95% CI 0.91-0.99; P = 0.022) and those who had shorter exposure to disease-modifying drugs compared to follow-up (aHR, 0.46; 95% CI, 0.25-0.81; P = 0.008).

In the pregnancy cohort, the risk of disability progression was associated with relapse in the postpartum year (aHR 1.85; 95% CI 1.11-3.06; P = 0.018). Longer exposure to disease-modifying drugs during follow-up was associated with a reduced risk of disability worsening (P <.010).

This study was limited by the recruitment of the control cohort from a single location and the fact that none of the women included were treated with fingolimod or natalizumab.

The data showed that women who relapsed in the year before conception were at an increased risk of the disability progression. Physicians should be aware of this association and consider advising their patients to attempt pregnancy only during periods of clinical stability.

Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.

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Portaccio E, Tudisco L, Pastò L, et al. Pregnancy in multiple sclerosis women with relapses in the year before conception increases the risk of long-term disability worsening. Mult Scler. Published online June 16, 2021. doi: 10.1177 / 13524585211023365