ANALYSIS OF THE COURSE OF PREGNANCY, DELIVERY AND POSTPARTUM PERIOD IN WOMEN WITH MULTIPLE SCLEROSIS

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Abstract

Background: Due to high prevalence of multiple sclerosis among women of childbearing age, special attention is paid to the problems of pregnancy management in such patients.

Aim: To study clinical particulars of the course of pregnancy, delivery and postpartum period in patients with multiple sclerosis.

Materials and methods: Eighty seven pregnant women with multiple sclerosis were followed up. Forty eight patients were taking disease modifying therapies (DMT), among them, 27 patients were taking glatiramer acetate, 17, interferon beta, 2, cladribine and 2, mitoxantrone. Thirty nine patients received no DMT. We evaluated the number and time to exacerbations; clinical particulars of the course of pregnancies and deliveries were studied depending on previous treatment with immune modulators.

Results: The rate of exacerbations during pregnancy decreased by 47.7% and increased by 12.4% in the postpartum period, compared to this parameter in the year before pregnancy. Most often, the attacks occurred in the first trimester (54.5%, р < 0.05) and in the first 6 months after delivery (40.1%, p < 0.05). A long remission before the pregnancy (2 years and more, р < 0.01), the use of the 1st line DMT just before conception (p < 0.01) and multiple pregnancies (р < 0.001) were all predictors of the reduced number of postpartum exacerbations of the disease. Pregnancy and delivery did not significantly affect the degree of neurological deficiency (mean EDSS at the postpartum period increased by 0.05 ± 0.01).

Conclusion: Multiple sclerosis and the use of DMT are not contraindications to pregnancy and delivery. Management of pregnancies and deliveries in multiple sclerosis patients does not differ from that in the general population. Previous use of DMT decreased the number of exacerbations during pregnancy and postpartum. Health status of the newborns, the numbers of complications during pregnancy and delivery, as well as changes in EDSS in the patients did not depend on previous DMT and on the time of its cessation.

About the authors

T. I. Yakushina

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

PhD, Senior Researсh Fellow, Department of Neurology

Russian Federation

S. V. Kotov

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: kotovsv@yandex.ru

MD, PhD, Professor; Head of Department of Neurology; Head of Chair of Neurology, Postgraduate Training Faculty

Russian Federation

M. A. Yakushin

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, PhD, Professor, Chair of Neurology, Postgraduate Training Faculty

Russian Federation

References

  1. Хондкариан ОА, Завалишин ИА, Невская ОМ. Рассеянный склероз. М.: Медицина; 1987. 256 с. Khondkarian OA, Zavalishin IA, Nevskaya OM. Rasseyannyy skleroz [Multiple sclerosis]. Moscow: Meditsina; 1987. 256 p. (in Russian).
  2. Hutchinson M. Pregnancy in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1993;56(10):1043–5.
  3. Малкова НА, Рябухина ОВ, Бабенко ЛА, Ионова ТИ, Киштович АВ. Связанное со здоровьем качество жизни у больных рассеянным склерозом. Журнал неврологии и психиатрии им. C.C. Корсакова. 2005;105(12):31–5. Malkova NA, Ryabukhina OV, Babenko LA, Ionova TI, Kishtovich AV. Svyazannoe so zdorov'em kachestvo zhizni u bol'nykh rasseyannym sklerozom [Health-related quality of life in multiple sclerosis patients]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2005;105(12):31–5 (in Russian).
  4. Котов СВ, Якушина ТИ, Лиждвой ВЮ. Клинико-эпидемиологические аспекты рассеянного склероза в Московской области. Журнал неврологии и психиатрии им. С.С. Корсакова. 2012;112(3):60–3. Kotov SV, Yakushina TI, Lizhdvoy VYu. Kliniko-epidemiologicheskie aspekty rasseyannogo skleroza v Moskovskoy oblasti [Clinical and epidemiological aspects of multiple sclerosis in the Moscow region]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2012;112(3):60–3 (in Russian).
  5. Котов СВ, Якушина ТИ, Лиждвой ВЮ. Длительное сравнительное исследование эффективности препаратов, изменяющих течение рассеянного склероза. Альманах клинической медицины. 2011;25:37–40. Kotov SV, Yakushina TI, Lizhdvoy VYu. Dlitel'noe sravnitel'noe issledovanie effektivnosti preparatov, izmenyayushchikh techenie rasseyannogo skleroza [Along-term comparative study of the efficacy of disease modifying therapies in multiple sclerosis]. Al'manakh klinicheskoy meditsiny. 2011;25:37–40 (in Russian).
  6. Шмидт ТЕ, Яхно НН. Рассеянный склероз: руководство для врачей. М.: МЕДпресс-информ; 2012. 272 с Shmidt TE, Yakhno NN. Rasseyannyy skleroz: rukovodstvo dlya vrachey [Multiple sclerosis: a manual for doctors]. Moscow: MEDpress-inform; 2012. 272 p. (in Russian)..
  7. Попова ЕВ, Кукель ТМ, Муравин АИ, Бойко АН, Мурашко АВ, Гусев ЕИ. Ретроспективный анализ течения беременности и родов у женщин с рассеянным склерозом. Журнал неврологии и психиатрии им. С.С. Корсакова. 2013;113(10):52–6. Popova EV, Kukel' TM, Muravin AI, Boyko AN, Murashko AV, Gusev EI. Retrospektivnyy analiz techeniya beremennosti i rodov u zhenshchin s rasseyannym sklerozom [Pregnancy and delivery in women with multiple sclerosis: a retrospective analysis]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2013;113(10):52–6 (in Russian).
  8. Dwosh E, Guimond C, Duguette P, Sadovnick A. The interaction of MS and pregnancy: a critical review. Int MS J. 2003;10(2): 38–42.
  9. Damek DM, Shuster EA. Pregnancy and multiple sclerosis. Mayo Clinic Proc. 1997;72(10):977–89.
  10. Sacks GP, Redman CW, Sargent IL. Monocytes are primed to produce the Th 1 type cytokine IL-12 in normal human pregnancy: an intracellular flow cytometric analysis of peripheral blood mononuclear cells. Clin Exp Immunol. 2003;131(3):393–5.
  11. Виноградская ЮБ, Радзинский ВЕ, Василенко ИА, Метелин ВБ. Витальная компьютерная фазометрия лимфоцитов периферической крови женщин в ранние сроки беременности. Вестник Российского университета дружбы народов. Серия: Медици- на. 2005;(4):78–83. Vinogradskaya YuB, Radzinskiy VE, Vasilenko IA, Metelin VB. Vital'naya komp'yuternaya fazometriya limfotsitov perifericheskoy krovi zhenshchin v rannie sroki beremennosti [Vital computer phasometry of peripheral blood lymphocytes in early pregnancy]. Vestnik Rossiyskogo universiteta druzhby narodov. Seriya: Meditsina. 2005;(4):78–83 (in Russian).
  12. Lorenzi AR, Ford HL. Multiple sclerosis and pregnancy. Postgrad Med J. 2002;78(922): 460–4.
  13. Alwan S, Yee I, Dybalski M, Guimond C, Dwosh E, Greenwood TM, Butler R, Sadovnick AD. Reproductive decision making after the diagnosis of multiple sclerosis. Mult Scler. 2013;19(3):351–8.
  14. Confavreux C, Hutchinson M, Hours MM, Cortinovis- Tourniaire P, Moreau T. Rate of pregnancy- related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998;339(5):285–91. 15. Sandberg-Wollheim M, Alteri E, Moraga MS, Kornmann G. Pregnancy outcomes in multiple sclerosis following subcutaneous interferon beta-1a therapy. Mult Scler. 2011;17(4):423–30.
  15. Salminen HJ, Leggett H, Boggild M. Glatiramer acetate exposure in pregnancy: preliminary safety and birth outcomes. J Neurol. 2010;257(12):2020

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Copyright (c) 2015 Yakushina T.I., Kotov S.V., Yakushin M.A.

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