Predictors and dynamics of postpartum relapses in women with multiple sclerosis

Stella E Hughes; Tim Spelman; Orla M Gray; Cavit Boz; Maria Trojano; Alessandra Lugaresi; Guillermo Izquierdo; Pierre Duquette; Marc Girard; Francois Grand'Maison; Pierre Grammond; Celia Oreja-Guevara; Raymond Hupperts; Roberto Bergamaschi; Giorgio Giuliani; Jeannette Lechner-Scott; Michael Barnett; Maria Edite Rio; Vincent van Pesch; Maria Pia Amato; Gerardo Iuliano; Mark Slee; Freek Verheul; Edgardo Cristiano; Ricardo Fernández-Bolaños; Dieter Poehlau; Maria Laura Saladino; Norma Deri; Jose Cabrera-Gomez; Norbert Vella; Joseph Herbert; Eli Skromne; Aldo Savino; Cameron Shaw; Fraser Moore; Steve Vucic; Tatjana Petkovska-Boskova; Gavin McDonnell; Stanley Hawkins; Frank Kee; Helmut Butzkueven; MSBase Study Group

doi:10.1177/1352458513507816

Predictors and dynamics of postpartum relapses in women with multiple sclerosis

Stella E Hughes, Tim Spelman, Orla M Gray, Cavit Boz, Maria Trojano, Alessandra Lugaresi, Guillermo Izquierdo, Pierre Duquette, Marc Girard, Francois Grand'Maison, Pierre Grammond, Celia Oreja-Guevara, Raymond Hupperts, Roberto Bergamaschi, Giorgio Giuliani, Jeannette Lechner-Scott, Michael Barnett, Maria Edite Rio, Vincent van Pesch, Maria Pia AmatoGerardo Iuliano, Mark Slee, Freek Verheul, Edgardo Cristiano, Ricardo Fernández-Bolaños, Dieter Poehlau, Maria Laura Saladino, Norma Deri, Jose Cabrera-Gomez, Norbert Vella, Joseph Herbert, Eli Skromne, Aldo Savino, Cameron Shaw, Fraser Moore, Steve Vucic, Tatjana Petkovska-Boskova, Gavin McDonnell, Stanley Hawkins, Frank Kee, Helmut Butzkueven^*, MSBase Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.

OBJECTIVE: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.

METHODS: An observational case-control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.

RESULTS: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.

CONCLUSION: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.

Original language	English
Pages (from-to)	739-46
Number of pages	8
Journal	Multiple Sclerosis Journal
Volume	20
Issue number	6
DOIs	https://doi.org/10.1177/1352458513507816
Publication status	Published - May 2014

Keywords

Adult
Aged
Case-Control Studies
Disability Evaluation
Female
Humans
Middle Aged
Multiple Sclerosis, Relapsing-Remitting
Postpartum Period
Pregnancy
Risk

Access to Document

10.1177/1352458513507816

Cite this

Hughes, S. E., Spelman, T., Gray, O. M., Boz, C., Trojano, M., Lugaresi, A., Izquierdo, G., Duquette, P., Girard, M., Grand'Maison, F., Grammond, P., Oreja-Guevara, C., Hupperts, R., Bergamaschi, R., Giuliani, G., Lechner-Scott, J., Barnett, M., Edite Rio, M., van Pesch, V., ... MSBase Study Group (2014). Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Multiple Sclerosis Journal, 20(6), 739-46. https://doi.org/10.1177/1352458513507816

@article{0711670a789e4458ba9a5750186b58e4,

title = "Predictors and dynamics of postpartum relapses in women with multiple sclerosis",

abstract = "BACKGROUND: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.OBJECTIVE: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.METHODS: An observational case-control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.RESULTS: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.CONCLUSION: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.",

keywords = "Adult, Aged, Case-Control Studies, Disability Evaluation, Female, Humans, Middle Aged, Multiple Sclerosis, Relapsing-Remitting, Postpartum Period, Pregnancy, Risk",

author = "Hughes, {Stella E} and Tim Spelman and Gray, {Orla M} and Cavit Boz and Maria Trojano and Alessandra Lugaresi and Guillermo Izquierdo and Pierre Duquette and Marc Girard and Francois Grand'Maison and Pierre Grammond and Celia Oreja-Guevara and Raymond Hupperts and Roberto Bergamaschi and Giorgio Giuliani and Jeannette Lechner-Scott and Michael Barnett and {Edite Rio}, Maria and {van Pesch}, Vincent and Amato, {Maria Pia} and Gerardo Iuliano and Mark Slee and Freek Verheul and Edgardo Cristiano and Ricardo Fern{\'a}ndez-Bola{\~n}os and Dieter Poehlau and Saladino, {Maria Laura} and Norma Deri and Jose Cabrera-Gomez and Norbert Vella and Joseph Herbert and Eli Skromne and Aldo Savino and Cameron Shaw and Fraser Moore and Steve Vucic and Tatjana Petkovska-Boskova and Gavin McDonnell and Stanley Hawkins and Frank Kee and Helmut Butzkueven and {MSBase Study Group}",

year = "2014",

month = may,

doi = "10.1177/1352458513507816",

language = "English",

volume = "20",

pages = "739--46",

journal = "Multiple Sclerosis Journal",

issn = "1352-4585",

publisher = "SAGE Publications Ltd",

number = "6",

}

Hughes, SE, Spelman, T, Gray, OM, Boz, C, Trojano, M, Lugaresi, A, Izquierdo, G, Duquette, P, Girard, M, Grand'Maison, F, Grammond, P, Oreja-Guevara, C, Hupperts, R, Bergamaschi, R, Giuliani, G, Lechner-Scott, J, Barnett, M, Edite Rio, M, van Pesch, V, Amato, MP, Iuliano, G, Slee, M, Verheul, F, Cristiano, E, Fernández-Bolaños, R, Poehlau, D, Saladino, ML, Deri, N, Cabrera-Gomez, J, Vella, N, Herbert, J, Skromne, E, Savino, A, Shaw, C, Moore, F, Vucic, S, Petkovska-Boskova, T, McDonnell, G, Hawkins, S, Kee, F, Butzkueven, H & MSBase Study Group 2014, 'Predictors and dynamics of postpartum relapses in women with multiple sclerosis', Multiple Sclerosis Journal, vol. 20, no. 6, pp. 739-46. https://doi.org/10.1177/1352458513507816

TY - JOUR

T1 - Predictors and dynamics of postpartum relapses in women with multiple sclerosis

AU - Hughes, Stella E

AU - Spelman, Tim

AU - Gray, Orla M

AU - Boz, Cavit

AU - Trojano, Maria

AU - Lugaresi, Alessandra

AU - Izquierdo, Guillermo

AU - Duquette, Pierre

AU - Girard, Marc

AU - Grand'Maison, Francois

AU - Grammond, Pierre

AU - Oreja-Guevara, Celia

AU - Hupperts, Raymond

AU - Bergamaschi, Roberto

AU - Giuliani, Giorgio

AU - Lechner-Scott, Jeannette

AU - Barnett, Michael

AU - Edite Rio, Maria

AU - van Pesch, Vincent

AU - Amato, Maria Pia

AU - Iuliano, Gerardo

AU - Slee, Mark

AU - Verheul, Freek

AU - Cristiano, Edgardo

AU - Fernández-Bolaños, Ricardo

AU - Poehlau, Dieter

AU - Saladino, Maria Laura

AU - Deri, Norma

AU - Cabrera-Gomez, Jose

AU - Vella, Norbert

AU - Herbert, Joseph

AU - Skromne, Eli

AU - Savino, Aldo

AU - Shaw, Cameron

AU - Moore, Fraser

AU - Vucic, Steve

AU - Petkovska-Boskova, Tatjana

AU - McDonnell, Gavin

AU - Hawkins, Stanley

AU - Kee, Frank

AU - Butzkueven, Helmut

AU - MSBase Study Group

PY - 2014/5

Y1 - 2014/5

N2 - BACKGROUND: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.OBJECTIVE: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.METHODS: An observational case-control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.RESULTS: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.CONCLUSION: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.

AB - BACKGROUND: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.OBJECTIVE: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.METHODS: An observational case-control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.RESULTS: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.CONCLUSION: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.

KW - Adult

KW - Aged

KW - Case-Control Studies

KW - Disability Evaluation

KW - Female

KW - Humans

KW - Middle Aged

KW - Multiple Sclerosis, Relapsing-Remitting

KW - Postpartum Period

KW - Pregnancy

KW - Risk

U2 - 10.1177/1352458513507816

DO - 10.1177/1352458513507816

M3 - Article

C2 - 24107309

SN - 1352-4585

VL - 20

SP - 739

EP - 746

JO - Multiple Sclerosis Journal

JF - Multiple Sclerosis Journal

IS - 6

ER -