#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 analgesia, caesarean 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 ...