| Contributors: |
Shipley, Jessica; Beadnall, Heidi N.; Sanfilippo, Paul G.; Yeh, Wei Zhen; Horakova, Dana; Havrdova, Eva Kubala; Hradilek, Pavel; Kalincik, Toma; Roos, Izanne; Prat, Alexandre; Girard, Marc; Rous, Zuzana; Pavelek, Zbysek; Gerlach, Oliver H. H.; Lechner-Scott, Jeannette; Alroughani, Raed; Ozakbas, Serkan; Peterka, Marek; Buzzard, Katherine; Skibina, Olga G.; Maimone, Davide; Foschi, Matteo; Surcinelli, Andrea; Karabudak, Rana; Spitaleri, Daniele L. A.; Lugaresi, Alessandra; Tomassini, Valentina; Gouider, Riadh; Mrabet, Saloua; Ferrando, Beatriz Romero; Hodgkinson, Suzanne; Štourač, Pavel; Guimarães, Joana; John, Nevin A.; Macdonell, Richard A. L.; Meca-Lallana, Jose E.; Butzkueven, Helmut; Van Der Walt, Anneke; Jokubaitis, Vilija G.; Null, Null; Varchova, Marta; Duquette, Pierre; Libertinova, Jana; Izquierdo, Guillermo; Eichau, Sara; Patti, Francesco; Boz, Cavit; Barnett, Michael; Ampapa, Radek; Martinkova, Alena; Ramo-Tello, Cristina; Grammond, Pierre; Van Pesch, Vincent; D'Amico, Emanuele; Weinstock-Guttman, Bianca; Shaygannejad, Vahid; Blanco, Yolanda; Kuhle, Jen; Grand'Maison, Francoi; Prevost, Julie; Pia Amato, Maria; Yamout, Bassem; J. Khoury, Samia; Terzi, Murat; Oreja-Guevara, Celia; Cartechini, Elisabetta; Laureys, Guy; Aguera-Morales, Eduardo; Di Gregorio, Maria; Altintas, Ayse; Turkoglu, Recai; D'Hooghe, Marie; Solaro, Claudio; Soysal, Aysun; Antonio Cabrera-Gomez, Jose; Habek, Mario; Willekens, Barbara; Etemadifar, Masoud; Edite Rio, Maria; Al-Harbi, Talal; G Kermode, Allan; Fabis-Pedrini, Marzena; M Carroll, William; Mccombe, Pamela; Houskova, Jana; Recmanova, Eva; Stetkarova, Ivana; Zakaria, Magd; Shalaby, Nevin; Castillo-Triviño, Tamara; Mohammad Baghbanian, Seyed; Simu, Mihaela; Slee, Mark; Massey, Jennifer; Oh, Jiwon; Naser Moghadasi, Abdorreza; De Gans, Koen; Al-Asmi, Abdullah; Laura Saladino, Maria; Lapointe, Emmanuelle |
| Description: |
Importance: Understanding the association between pregnancy and clinical outcomes in women with moderate to severe multiple sclerosis (MS) disability is crucial for guiding family planning and management strategies. Objective: To assess peripregnancy relapse activity and disability progression in women with a preconception Expanded Disability Status Scale (EDSS) score of 3 or higher. Design, Setting, and Participants: This multicenter retrospective cohort study used data from the MSBase Registry, with clinical observations spanning 1984 through 2024. Study cohorts included pregnant women with MS with a preconception EDSS score of 3 or higher (range: 3-10, with higher scores indicating more severe MS-related disability) and propensity score-matched nonpregnant women with MS (controls). Main Outcomes and Measures: The main outcomes were peripregnancy annualized relapse rates (ARRs) and time to 6-month confirmed disability worsening (CDW). Results: A total of 1631 women with MS were included, of whom 575 were in the pregnant cohort (median [IQR] age at pregnancy, 32.5 [29.1-36.1] years) and 1056 were in the nonpregnant cohort (median [IQR] age, 32.6 [27.5-37.2] years). The median (range) preconception EDSS score was 3.5 (3.0-7.5). Relapse activity decreased during pregnancy, with a 75% reduction in ARR during the first trimester (rate ratio [RR], 0.25; 95% CI, 0.15-0.43), and increased to 36% above preconception levels in the first 3 months post partum (RR, 1.36; 95% CI, 1.06-1.75). Relapse during pregnancy was associated with a higher preconception ARR (odds ratio [OR], 1.56; 95% CI, 1.10-2.20) and preconception use of natalizumab (OR, 4.42; 95% CI, 1.24-23.57) or fingolimod (OR, 14.07; 95% CI, 2.81-91.30). Older age (OR, 0.92; 95% CI, 0.85-0.99) and continuation of disease-modifying therapy into pregnancy (OR, 0.42; 95% CI, 0.19-1.00) were associated with reduced risk. Disease-modifying therapy reinitiation within 1 month post partum was associated with lower odds of early postpartum relapse (OR, 0.45; 95% CI, ... |