Pregnancy and fetal outcomes after interferon-β exposure in multiple sclerosis

被引:118
作者
Amato, M. P. [1 ]
Portaccio, E. [1 ]
Ghezzi, A. [3 ]
Hakiki, B. [1 ]
Zipoli, V. [1 ]
Martinelli, V. [2 ]
Moiola, L. [2 ]
Patti, F. [4 ]
La Mantia, L. [5 ]
Mancardi, G. L. [6 ]
Solaro, C. [7 ]
Tola, M. R. [8 ]
Pozzilli, C. [9 ]
De Giglio, L. [9 ]
Totaro, R. [10 ]
Lugaresi, A. [11 ]
Di Tommaso, V. [11 ]
Paolicelli, D. [12 ]
Marrosu, M. G. [13 ]
Comi, G. [2 ]
Pellegrini, F. [14 ,15 ]
Trojano, M. [12 ]
机构
[1] Univ Florence, Dept Neurol, I-50134 Florence, Italy
[2] Univ Milan, San Raffaele Inst, Milan, Italy
[3] Hosp Gallarate, Gallarate, VA, Italy
[4] Univ Catania, Dept Neurol, Catania, Italy
[5] Besta Inst, Milan, Italy
[6] Univ Genoa, Dept Neurol, Genoa, Italy
[7] ASL3 Genovese, Dept Neurol, Genoa, Italy
[8] Univ Ferrara, Dept Neurol, I-44100 Ferrara, Italy
[9] Univ Roma La Sapienza, S Andrea Hosp, Dept Neurol Sci, Multiple Sclerosis Ctr, Rome, Italy
[10] Univ Aquila, Dept Neurol, I-67100 Laquila, Italy
[11] Univ G DAnnunzio, Dept Neurosci & Imaging, Chieti, Italy
[12] Univ Bari, Dept Neurol, Bari, Italy
[13] Univ Cagliari, Dept Neurol, Cagliari, Italy
[14] Consorzio Mario Negri Sud, Dept Clin Pharmacol & Epidemiol, Chieti, Italy
[15] Sci Inst Casa Sollievo della Sofferenza, Biostat Unit, Foggia, Italy
关键词
DELIVERY; WOMEN;
D O I
10.1212/WNL.0b013e3181fd62bb
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To assess pregnancy and fetal outcomes after in utero exposure to interferon-beta (IFN beta) in all pregnancies occurring in women with multiple sclerosis (MS) during the study period, with a specific focus on the risk of spontaneous abortion. Methods: In this cohort study, data were gathered through a standardized, semi-structured interview. Patients who discontinued IFN beta less than 4 weeks from conception (exposed) were compared with those who had discontinued the drug at least 4 weeks from conception or who were never treated (not exposed). Possible confounders were handled through multivariate analyses adjusted for propensity score (PS). Results: We collected data on 396 pregnancies in 388 women, 88 classified as exposed (mean exposure 4.6 +/- 5.8 weeks). IFN beta exposure was not associated with an increased risk of spontaneous abortion (PS-adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 0.4 to 2.9, p = 0.88), although it was associated with both lower baby weight (PS-adjusted beta -113.8, p < 0.0001) and length (PS-adjusted beta -1.102, p < 0.0001). Proportion of spontaneous abortion in exposed patients fell within the range expected for the Italian population in the same period. IFN beta exposure (PS-adjusted OR 2.11, 95% CI 1.18 to 3.78, p = 0.012) and cesarean delivery were the only predictors of preterm delivery. In the exposed group, we did not observe any significant fetal complications, malformations, or developmental abnormalities over a median follow-up of 2.1 years. Conclusions: Our findings point to the relative safety of IFN beta exposure times of up to 4 weeks and can assist neurologists facing therapeutic decisions in women with MS with a pregnancy plan. Neurology (R) 2010;75:1794-1802
引用
收藏
页码:1794 / 1802
页数:9
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