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 journalArticleAcademicpeer-review


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 languageEnglish
Pages (from-to)739-46
Number of pages8
JournalMultiple Sclerosis Journal
Issue number6
Publication statusPublished - May 2014


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

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