Predicting relapses after the baby

I would recommend getting on top of your disease before starting a family. #MSBlog #MSResearch

"The study below confirms the favourable effect of pregnancy on MS relapses. In addition, it shows that pre-conception DMT exposure and low baseline relapse rate were independently protective against postpartum relapses. This should be reassuring for woman with MS and will encourage them to get on top of their MS disease activity before planning a family. Some of the existing treatments, in particular glatiramer acetate, and emerging therapies, alemtuzumab, are ideally suited for woman planning to start a family. Alemtuzumab is the first induction therapy to get a license in Europe; induction therapies should be appealing to women, because once you have had alemtuzumab and your disease is under control the drug is out of your system and hence will have no impact on pregnancy. Obviously the autoimmune complication from alemtuzumab will still need to be monitored for during pregnancy as they may have an impact on the developing baby if they emerge whilst you are pregnant, for example an overactive thyroid. These problems, however, can all be managed."

Epub: Hughes et al. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler. 2013 Oct 9.

BACKGROUND: Several studies have shown that pregnancy reduces MS relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.

OBJECTIVE: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.

METHODS: An observational case-control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.

RESULTS: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.

CONCLUSION: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early post-partum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise post-partum relapse risk in women with MS planning pregnancy.

CoI: multiple