MS may not worsen after pregnancy
Despite long-held beliefs, women with multiple sclerosis did not demonstrate increased risk for relapse after pregnancy, breastfeeding and resuming disease-modifying treatments, according to research that will be presented at the American Academy of Neurology Annual Meeting.
“A decreased risk of relapse during pregnancy but significant rebound disease activity in the early postpartum period was reported in women with MS recruited from referral centers over 20 years ago prior to availability of disease-modifying treatments (DMTs) or MRIs to diagnosis patients with a single attack,” Annette Langer-Gould, MD, PhD, from Kaiser Permanente Southern California, and colleagues wrote.
To determine if there is still an increased risk of MS relapse after giving birth today, Langer-Gould and colleagues analyzed electronic health record and survey data from a contemporary cohort of pregnant women with MS. The survey asked the women about their treatment, breastfeeding and relapse history.
Among the 375 enrolled women, there were 466 pregnancies between 2008 and 2016.
Data indicated that during the year before conception, 38% of women did not receive any treatment for MS. During pregnancy, clinically isolated syndrome was present in 14.6% of women and relapse occurred in 8.4% of women.
In the first year after giving birth, 26.4% of women relapsed, 87% breastfed, 35% breastfed exclusively and 41.2% resumed DMTs.
Prior to pregnancy, the annual relapse rate was 0.39. This rate declined to 0.14 to 0.07 during pregnancy.
There was no rebound disease activity in the postpartum period. In the first 3 months after birth, the annual relapse rate was slightly lower than the rate before pregnancy at 0.27. The rates returned to the level prior to pregnancy (0.37) at 4 to 6 months.
Women who breastfed exclusively for at least 2 months had a 40% lower risk for postpartum relapse (adjusted HR = 0.58) than women who did not breastfeed and those who supplemented breast milk with formula. Resuming modestly effective DMTs after birth did not affect postpartum relapse.
After adjusting for factors that may affect relapse rate, including severity of MS before pregnancy, the results remained the same.
“These results are exciting, as MS is more common among women of childbearing age than in any other group,” Langer-Gould said. “This shows us that women with MS today can have children, breastfeed and resume their treatment without experiencing an increased risk of relapses during the postpartum period.” – by Alaina Tedesco
Langer-Gould A, et al. Pregnancy-related relapses in a large, contemporary multiple sclerosis cohort: No increased risk in the postpartum period. Presented at: American Academy of Neurology Annual Meeting; May 4-10; Philadelphia.
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