MS Relapse After Pregnancy Is Not as Common as Once Believed
The risk of women with multiple sclerosis (MS) relapsing during postpartum is much lower than previously believed, according to a new study. In fact, most women with MS can have children, breastfeed, and resume modestly effective disease-modifying therapies (DMTs) without an increased risk of relapses during the postpartum period.1
“These results are exciting, as MS is more common among women of childbearing age than in any other group,” said lead author Dr Annette Langer-Gould.2
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The study’s findings will be presented at the American Academy of Neurology’s 71st Annual Meeting in May.
The belief that there would be an increased risk for relapse after pregnancy was determined more than 20 years ago, according to Dr Langer-Gould. To assess whether medical and technological advancements have helped decrease the risk, the researchers analyzed data on 375 women with MS.
In total, the participants—who were identified through the complete electronic health record (EHR) at Kaiser Permanente Southern and Northern California between 2008 and 2016—had 466 pregnancies.
To reach their conclusions, the researchers evaluated the EHR of the participants and their babies as well as the responses to interviewer-administered surveys on treatment history, breastfeeding, and relapse.
In the year prior to conception, 38.0% of the participants had not been taking any treatment. At the start of pregnancy, 14.6% of the participants had clinically isolated syndrome. During pregnancy, 8.4% of the participants relapsed.
In the postpartum year, 87% of the participants breastfed with 35% of those doing so exclusively, 41.2% of participants resumed DMTs, and 26.4% relapsed.
The researchers determined that participants who had exclusively breastfed reduced the risk for postpartum relapses by about 40% compared with participants who did not breastfeed and that participants who supplemented breastfeeding with formula were just as likely to have a relapse than those who did not breastfeed at all. Resuming DMTs had no effect.2
The annualized relapse rate declined from 0.39 pre-pregnancy to 0.14-0.07 during pregnancy. After having been slightly suppressed in the first 3 months of the postpartum period, the annualized relapse rates returned to the pre-pregnancy rates at 4 to 6 months.
“The lack of rebound disease activity in the early postpartum period is likely due to a combination of inclusion of women from a population-based setting, those diagnosed after a single relapse, and high rates of exclusive breastfeeding,” the researchers concluded.1
—Colleen Murphy
References:
1. Langer-Gould A, Smith J, Albers K, et al. Pregnancy-related relapses in a large, contemporary multiple sclerosis cohort: no increased risk in the postpartum period [published online March 7, 2019]. https://www.aan.com/PressRoom/Home/GetDigitalAsset/12898.
2. Good news for women with MS: disease may not worsen after pregnancy after all [press release]. Minneapolis, MN: American Academy of Neurology; May 4-10, 2019. https://www.aan.com/PressRoom/Home/PressRelease/2703. Accessed March 8, 2019.