Clinic Speak: relapses after birth: the message is get back onto your DMT ASAP. Is this correct?

The questions woman need answered in relation to MS and pregnancy. #ClinicSpeak #MSBlog #MSResearch

“If you are a woman of childbearing age this study will be of interest to you. It shows that you have almost a 50% chance of having a relapse in the year after your deliver your baby and you disease severity and activity prior to fall pregnant and during pregnancy predicts your risk of having a relapse postpartum. Woman with higher disability and relapses in the year prior to falling pregnant and during pregnancy were more likely to relapse after the delivery of the baby. The authors encourage woman at high risk of post-partum relapses to get back onto a DMT as soon as possible. This advice, however, ignores the wishes of many woman to breast feed post-partum and the evidence from a meta-analysis that breast feeding may lower the chances of relapse.”

“I have once said we should label MS a pink ribbon disease as the majority of MSers are woman who develop the disease during their child bearing years. This study now adds to the complexity of the decisions a woman with MS and her family have to make in relation to having children.”
  1. Does MS affect my fertility? 
  2. Will pregnancy affect the course of my MS?
  3. Will I be able to breast feed after delivery?
  4. How long before I fall pregnant must I stop my DMT?
  5. If I fall pregnant on a DMT will this affect the baby?
  6. Can I breast feed on my DMT? 
  7. Will I be able to be a good parent if I become disabled from my MS?
  8. If I become disabled or unemployed as a result of MS will I be able to support my children?
  9. What is the risk of my children getting MS?
  10. Can I do anything to prevent them from getting MS?
  11. Am I more likely  to need an assisted delivery because I have MS?
  12. Will I be able to have a normal vaginal delivery?
  13. Will I be able to have an epidural during labour?
  14. How you treat hyperemesis gravidarum during pregnancy?
  15. Should I continue taking my other drugs for my MS symptoms during pregancy?
  16. What is the best treatment strategy for my MS? Should I go onto a DMT and get my MS under control before starting a family or should I first start my family?
  17. What is the best treatment strategy for my MS to maximise my chances of having a family and keeping my MS under control?
  18. How will having neutralizing anti-interferon beta antibodies affect my baby?
  19. Can I have IVF? Will the drugs that are used to induce ovulation affect my MS?
  20. What dose of vitamin D do you advise during pregnancy? 
  21. Are oral contraceptive safer for my MS? Which contraceptive do you recommend? 

OBJECTIVE: To assess relapses, disability progression and the role of disease modifying drugs (DMDs) in the year after delivery in women with multiple sclerosis (MS).

METHODS: We prospectively followed-up pregnancies occurring between 2002 and 2008 in women with MS, recruited from 21 Italian MS centres. The risk of relapses and disability progression in the year after delivery was assessed.

RESULTS: 350 out of 423 pregnancies were assessed (pregnancies not resulting in live birth and with a postpartum follow-up period shorter than 1 year were excluded from the analysis). 148 patients (42.3%) had at least one relapse in the year after delivery. An Expanded Disability Status Scale (EDSS) score at conception ≥2.0 (HR=1.4; 95% CI 1.1 to 2.0; p=0.046) and a higher number of relapses before (HR=1.5; 95% CI 1.2 to 1.8; p<0.001) and during pregnancy (HR=2.3; 95% CI 1.6 to 3.4; p<0.001) were related to a higher risk of post-partum relapses. On the contrary, early DMD resumption after delivery marginally reduced the risk of post-partum relapses (HR=0.7, 95% CI 0.4 to 1.0; p=0.079). Moreover, 44/338 women progressed by at least one point on the EDSS. Disability progression was associated with a higher number of relapses before (HR=1.4, 95% CI 1.1 to 1.9; p=0.047) and after delivery (HR=2.7, 95% CI 1.4 to 5.2; p=0.002).

CONCLUSIONS: Our findings show an increased risk of postpartum relapses and disability accrual in women with higher disease activity before and during pregnancy. Since it may reduce the risk of post-partum relapses, early DMD resumption should be encouraged, particularly in patients with more active disease.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


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