Sunday, 6 January 2013

Research: ceasarean sections and epidurals are safe

#MSBlog: pregnancy in MS; caesarian section and epidural anaesthesia are safe regarding the course of your disease; but not post-partum relapses.

Epub: Pastò et al. Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study. BMC Neurol. 2012;12:165.

BACKGROUND: Few studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women MSers. 


OBJECTIVE: The objective of this study was to assess the impact of epidural analgesia and caesarean delivery on the risk of post-partum relapses and disability in women MSers.

METHODS: In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women MSers regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and 
epidural analgesia  The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis.

RESULTS: We collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5+/-3.1 years). 155 MSers (44.4%) underwent 
caesarean delivery  and 65 (18.5%) epidural analgesia. In the multivariate analysis neither caesarean delivery  nor epidural analgesia ere associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95%CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95%CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, caesarean delivery and epidural analgesia are not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95%CI 2.0-8.2; p<0.001; disability progression over the whole follow-up period: OR= 2.0; 95%CI 1.2-3.3; p=0.005).

CONCLUSIONS: These findings, show no correlation between 
epidural analgesiacaesarean delivery and postpartum relapses and disability. Therefore these procedures can safely be applied in MSers. On the other hand, post-partum relapses are significantly associated with increased disability, which calls for the need of preventive therapies after delivery. 



"Good news for woman MSers; caesarian sections and epidural anaesthesia has no impact on MS."


"Not surprising post-partum relapses were associated with disability progression; as most of these woman were either on or going back onto DMTs it confirms numerous other studies that have demonstrated that relapses  on DMTs are bad news. This is contrary to natural history data, i.e. not on DMTs, that show that relapses are a poor predictor of disability progression. Why the disconnect between natural history and DMT related relapses is interesting and is telling us something fundamental about this disease. I suspect that if you are having relapses on DMTs the DMT is clearly not affecting that component of the disease that is driving relapses. What that is one of the grand challenges in MS."

Other blog posts on pregnancy

Research: Having a baby? Pregnancy and glatiramer acetate
25 Oct 2012
Research: Having a baby? Pregnancy and glatiramer acetate. Epub: Giannini et al. Pregnancy and foetal outcomes after Glatiramer Acetate exposure in patients with multiple sclerosis: a prospective observational multicentric ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Research: Pregnancy and MS
14 Aug 2012
The mean annual relapsing rate 4 years prior to pregnancy was significantly higher than at the subsequent 6 years after delivery (1.06 vs. 0.45, p < 0.001). In addition, the annual relapsing rate in years prior to pregnancy was ...
http://multiple-sclerosis-research.blogspot.com/

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05 Jun 2012
BACKGROUND AND OBJECTIVE: Women with multiple sclerosis (MS) who intend to get pregnant are often advised to discontinue disease modifying therapy (DMT) prior to conception. This recommendation is not based on ...
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Multiple Sclerosis Research: Research: NMO and Pregnancy
14 Apr 2012
Research: NMO and Pregnancy. Epub ahead of print: Kim W et al. Influence of pregnancy on neuromyelitis optica spectrum disorder.Neurology 2012 Apr 4. OBJECTIVE: To investigate the influence of pregnancy on patients ...
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Multiple Sclerosis Research: Vitamin D intake during pregnancy is ...
28 Jul 2011
This allowed these investigators to study the association of maternal milk intake, maternal dietary vitamin D intake, and predicted maternal serum vitamin D during pregnancy and their daughters' risk of developing MS.
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Article of interest (7): Pregnancy is associated with a better prognosis
16 Jul 2011
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Multiple Sclerosis Research: Pregnancy and natalizumab: results of ...
31 May 2011
Of the women exposed to natalizumab during pregnancy, 29 women gave birth to 28 healthy children; one child was born with hexadactyly (an extra finger), 5 pregnancies ended in an early miscarriage and one woman ...
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Article of interest (6) - Effect of pregnancy on relapses - Multiple ...
15 Jul 2011
The average or mean rate of relapse was 0.7 per year in the year before pregnancy, 0.5 during the first trimester, 0.6 during the second trimester and 0.2 during the third. The rate increased to 1.2 during the first three months ...
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Multiple Sclerosis Research: Pregnancy outcomes in MS'ers on DMTs
16 Sep 2011
Pregnancy outcomes in MS'ers on DMTs. Epub ahead of print: Lu et al. Perinatal outcomes in women with multiple sclerosis exposed to disease-modifying drugs. Mult Scler. 2011 Sep 13. Background: The incidence of ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Are you pregnant or planning to fall ...
15 Nov 2012
This has been hypothesised to be related to maternal vitamin D levels during pregnancy, although conclusive evidence to support this is lacking. To date, no large studies of latitudinal variation in the month of birth effect have ...
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Multiple Sclerosis Research: Pregnancy and foetal outcomes after ...
20 Dec 2010
No significant fetal complications, malformations, or developmental abnormalities were noted with a follow-up of 2 years. These findings point to the relative safety of IFNβ foetal exposure of up to 4 weeks during pregnancy.
http://multiple-sclerosis-research.blogspot.com/

Research: pregancy does not appear to influence your MS fate
27 May 2012
Prospective studies have reported a significant decline by two-thirds in the rate of relapses during the third trimester of pregnancy and a significant increase by two-thirds during the first 3 months post-partum (after delivery).
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Research: information about having a ...
28 Oct 2012
However, the topic is important and if we want to provide holistic care for woman with MS we need to address how we handle the issue of pregnancy and the advice we give. Misinformation or inconsistent information is one ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Research: Choosing to Have a Baby
16 Jul 2012
Of the 20.9% of participants who decided to become pregnant (or father a pregnancy) following a diagnosis of MS, 49.5% had two or more pregnancies. Conclusion:This study indicates that an MS diagnosis does not ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Schtop or Not. Pregnacy and MS
05 Aug 2011
As is well known the relapse rate decreases during pregnancy, but as is known to occur there was a surge in relapses within 3 months after the birth. However when doctors looked at 9 months after birth compared to before ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Delivery of healthy babies after ...
18 Apr 2011
The authors describe the pregnancy and outcome in two women with MS using natalizumab. The first patient ... The second patient did not experience MS relapses during pregnancy, while still using natalizumab. Importantly ...
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8 comments:

  1. This begs the question: Should women with MS choose to have children? What are the implications both for the health of the MSer and the emotional wellbeing of her child?

    To willingly have children after a diagnosis of MS seems questionable. It's no different from images of starving people in Africa having multiple births even though their children will suffer in unprecedented ways.

    We're lucky enough to have higher levels of education and understanding, therefore why do we push to have children when the odds are stacked against us?

    ReplyDelete
    Replies
    1. Some of the research posted above answer your question about the implications for the health of the woman: pregnancy does not appear to influence your MS fate.

      Why do we push to have children? It's the only way to get them out
      (bada boom)

      Delete
  2. Er, that's supposing that all MS is the same. It isn't.
    After 13 years, I'm still fit and walking. I've been on beta-interferon for 12 of these years and after it started working, I've had 3 relapses.
    I had my kids before diagnosis, but would still have had MS brewing away in my brain.
    Okay, that's just me, but I have plenty of friends with kids who are still well.
    What next? The health police are going to have anyone with a diagnosis sterilised for their own good and the emotional wellbeing of their children?
    Daft. We do what we can. If we have kids, we treasure them and give them the best we can. Okay, so mum can't walk 3 miles, but then neither can a 5 year old.
    Oh dear, the comments on here can be so frustrating, ignorant and plain insulting and quite often extraordinarily illogical.

    ReplyDelete
    Replies
    1. Actually all MS is principally the same, it just affects the sufferer in different ways and at varying timelines. All MSers are headed in the same direction and have the exact pathology at play. It's all brain damage. It's neurology. It's all biology.

      Delete
  3. These professionals just copy n paste links most of the time they havent a clue about MS and never will and have never given birth either

    ReplyDelete
    Replies
    1. Alt C & Alt V and a little bit more!

      Delete
    2. If a male can give give birth then we can empathise but for the male professionals your comments are not very useful as a .....

      Delete

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