Predictors and dynamics of postpartum relapses in women with multiple sclerosis

被引：144

作者：

Hughes, Stella E. ^{[1
,2
]}

Spelman, Tim ^{[3
]}

Gray, Orla M. ^{[4
]}

Boz, Cavit ^{[5
]}

Trojano, Maria ^{[6
]}

Lugaresi, Alessandra ^{[7
]}

Izquierdo, Guillermo ^{[8
]}

Duquette, Pierre ^{[9
]}

Girard, Marc ^{[9
]}

Grand'Maison, Francois ^{[10
]}

Grammond, Pierre ^{[11
]}

Oreja-Guevara, Celia ^{[12
]}

Hupperts, Raymond ^{[13
]}

Bergamaschi, Roberto ^{[14
]}

Giuliani, Giorgio ^{[15
]}

Lechner-Scott, Jeannette ^{[16
]}

Barnett, Michael ^{[17
]}

Rio, Maria Edite ^{[18
]}

van Pesch, Vincent ^{[19
]}

Amato, Maria Pia ^{[20
]}

Iuliano, Gerardo ^{[21
]}

Slee, Mark ^{[22
]}

Verheul, Freek ^{[23
]}

Cristiano, Edgardo ^{[24
]}

Fernandez-Bolanos, Ricardo ^{[25
]}

Poehlau, Dieter ^{[26
]}

Laura Saladino, Maria ^{[27
]}

Deri, Norma ^{[28
]}

Cabrera-Gomez, Jose ^{[29
]}

Vella, Norbert ^{[30
]}

Herbert, Joseph ^{[31
]}

Skromne, Eli ^{[32
]}

Savino, Aldo

Shaw, Cameron ^{[33
]}

Moore, Fraser ^{[34
]}

Vucic, Steve ^{[35
]}

Petkovska-Boskova, Tatjana ^{[36
]}

McDonnell, Gavin ^{[1
]}

Hawkins, Stanley ^{[1
,37
]}

Kee, Frank ^{[2
]}

Butzkueven, Helmut ^{[3
,38
,39
]}

机构：

[1] Royal Victoria Hosp, Dept Neurol, Belfast BT12 6BA, Antrim, North Ireland

[2] Queens Univ Belfast, UKCRC Ctr Excellence Publ Hlth Res, Belfast BT7 1NN, Antrim, North Ireland

[3] Royal Melbourne Hosp, Dept Neurol, Parkville, Vic 3050, Australia

[4] Ulster Hosp, Belfast, Antrim, North Ireland

[5] Karadeniz Tech Univ, Trabzon, Turkey

[6] Univ Bari, I-70121 Bari, Italy

[7] Univ G DAnnunzio, Dept Neurosci & Imaging, MS Ctr, Chieti, Italy

[8] Univ Hosp, Seville, Spain

[9] Hop Notre Dame de Bon Secours, Montreal, PQ H2L 4K8, Canada

[10] Neuro Rive Sud, Quebec City, PQ, Canada

[11] Hotel Dieu Levis, Quebec City, PQ, Canada

[12] Hosp Univ Clin San Carlos, IdISSC, Madrid, Spain

[13] Orbis Med Ctr, Sittard, Netherlands

[14] Neurol Inst IRCCS Mondino, Pavia, Italy

[15] Osped Macerata, Macerata, Italy

[16] John Hunter Hosp, Sydney, NSW, Australia

[17] Brain & Mind Res Inst, Sydney, NSW, Australia

[18] Hosp Sao Joao, Oporto, Portugal

[19] Clin Univ St Luc, B-1200 Brussels, Belgium

[20] Univ Florence, Dept Neurol, I-50121 Florence, Italy

[21] Osped Riuniti Salerno, Salerno, Italy

[22] Flinders Med Ctr, Adelaide, SA, Australia

[23] Groen Hart Ziekenhuis, Gouda, Netherlands

[24] Hosp Italiano Buenos Aires, Buenos Aires, DF, Argentina

[25] Hosp Univ Virgen de Valme, Seville, Spain

[26] Multiple Sclerosis Ctr Kamillus Klin, Asbach, Germany

[27] INEBA, Buenos Aires, DF, Argentina

[28] Hosp Fernandez, Buenos Aires, DF, Argentina

[29] Ctr Internac Restaurac Neurol, Havana, Cuba

[30] Mater Dei Hosp, Msida, Malta

[31] NYU, Langone Med Ctr, New York, NY 10003 USA

[32] Hosp Especialidades Ctr Med La Raza, Ctr Med Nacl Siglo 21, Mexico City, DF, Mexico

[33] Geelong Hosp, Geelong, Vic, Australia

[34] McGill Univ, Jewish Gen Hosp, Montreal, PQ H3T 1E2, Canada

[35] Westmead Hosp, Westmead, NSW, Australia

[36] Clin Neurol Clin Ctr, Skopje, North Macedonia

[37] Queens Univ Belfast, Ctr Med Educ, Belfast BT7 1NN, Antrim, North Ireland

[38] Univ Melbourne, Melbourne Brain Ctr, Dept Med, Parkville, Vic 3050, Australia

[39] Monash Univ, Box Hill Hosp, Dept Neurol, Clayton, Vic 3800, Australia

来源：

MULTIPLE SCLEROSIS JOURNAL | 2014年 / 20卷 / 06期

关键词：

Multiple sclerosis; disability progression; disease-modifying treatments; pregnancy; relapsing-remitting; PREGNANCY; OUTCOMES;

D O I：

10.1177/1352458513507816

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：739 / 746

页数：8

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