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New Findings on Pregnancy and Outcomes in MS

November 8, 2018

SUMMARY
  • Two new studies using data from medical claims show that the rate of pregnancy is increasing among women with MS, and that women with MS tend to have more complications (compared to women without MS). The studies also show an unexpectedly low use of MS disease-modifying therapies before and after pregnancy.
  • In general, pregnancy does not appear to affect the long-term clinical course of MS. Women who have MS and wish to have a family can usually do so successfully with the assistance of their neurologist and obstetrician.
  • The team (Maria Houtchens, MD, Harvard Medical School, Boston, and colleagues) report their findings in Neurology (October 23, 2018; 91 (17), and (October 23, 2018; 91 (17), both available via open access).
 
DETAILS
Background: MS is more prevalent in women of childbearing age than in any other group. When young women receive a diagnosis of MS, they frequently have questions about the effects of the disease on childbearing—and vice versa. Studies undertaken over the past several decades allow health professionals to provide answers to some of these questions. In general, pregnancy does not appear to affect the long-term clinical course of MS, and some studies have suggested that pregnancy outcomes for women with MS are not different than those of women without MS. Women who have MS and wish to have a family can usually do so successfully with the assistance of their neurologist and obstetrician.
 
The Studies:  For these studies, the team used data from a database that has compiled information on medical insurance claims since 2006, from more than 150 million people enrolled in insurance plans nationwide.
 
Pregnancy rates and outcomes: The team compared annual pregnancy rates in women with and without MS. From 2006 to 2014, pregnancy rates in women with MS increased from 7.91% to 9.47% and decreased in women without MS from 8.83% to 7.75%. These differences were statistically significant. The average age of pregnant women with MS was greater than women without MS (32.5 years vs. 29.3 years).
 
The team also looked at complications in women with and without MS who gave birth. They found a higher rate of claims for several complications among women with MS, including premature labor, infections during pregnancy, and fetal malformations or damage.
 
The team (Maria Houtchens, MD, Harvard Medical School, Boston, and colleagues) report their findings in Neurology (October 23, 2018; 91 (17), available via open access).

Comment: In an accompanying editorial, Paola Cavalla, MD (City of Health & Science University, Turin, Italy) and Wendy Gilmore, PhD (University of Southern California, Los Angeles) comment that the increase in pregnancy rates may be due to the development of “appropriate, proactive and timely” family planning counseling at MS centers. They also comment that the increased rate of complications may be overestimated in a population of women who all have insurance.
 
Relapses and treatment: In a separate study, the team looked at relapse rate and use of disease-modifying therapies in 2,158 women with MS. The findings confirmed previous findings, that relapse risk reduced during pregnancy and increased within the six months after childbirth. Other results showed that only 20% of these women used disease-modifying therapies before pregnancy, and an unexpectedly low 25.5% used them during the year after childbirth, when the risk of MS relapse is elevated.
 
The team (Maria Houtchens, MD, Harvard Medical School, Boston, and colleagues) report their findings in Neurology (October 23, 2018; 91 (17), available via open access).

Comment: In their editorial, Drs. Cavalla and Gilmore comment that the low use of treatment after pregnancy may reflect breastfeeding practices, and the low use before pregnancy may be a result of healthcare providers recommending withdrawal in women with MS planning a pregnancy. They add that more data are needed to provide women with comprehensive information on treatment use in pregnancy planning, the pregnancy itself, and lactation practices.
 
Read More
Read about pregnancy and other reproductive issues
Download the Pregnancy, Delivery and Postpartum fact sheet (.pdf)

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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