Abstract
Objectives: data on pregnancy long-term effects on multiple sclerosis (MS) course are still controversial; whether experiencing more than one pregnancy exposes one to risk of the disability‘s accrual is still unknown. We investigated differences existing in terms of disability progression among women with MS (wwMS) who had one or more children after their MS onset. Methods: Monoparous and multiparous wwMS were enrolled from the Catania MS Center, Italy, in a monocenter retrospective study. A Cox proportional hazards model was used to examine the effect of the number of parities on time from MS disease onset to EDSS 4.0 and 6.0. The study protocol was approved by the local Ethical Committee. Results: during the seven years of observation, 32.1% and 23.2% of the monoparous group reached expanded disability disease status (EDSS) 4.0 and 6.0 respectively, compared to 13.3% and 3.3% of the multiparous group (p = 0.057 and p = 0.017; respectively). The Kaplan–Meier curve analysis showed no statistically-significant differences between the two groups in reaching the two milestones. The multiparous group showed a longer time to reach the EDSS 4.0 (3.5 vs. 2.6 years, log-rank 0.57, p = 0.45). The Cox regression analysis showed that the EDSS at the time of first pregnancy (Exp(B) 9.4, CI 4.5–19.7, p < 0.001) and the time from MS onset to first pregnancy (Exp(B) 0.96, CI = 0.93–0.98, p < 0.05) were significant predictors of reaching the EDSS 4.0, whereas a model including only the EDSS one year after the first pregnancy significantly predicted (Exp(B) value of 6.4, CI 2.6–15.4, p < 0.001) the reaching of EDSS 6.0. Conclusions: Our results suggest that experiencing more than one pregnancy could not convey a different clinical outcome in wwMS. Further research is needed to confirm our results.
Highlights
Multiple sclerosis (MS) is an immune-mediated disease that leads to demyelization and axonal loss in the central nervous system
Previous studies have been conducted to investigate the role of pregnancy on disability progression, supporting that parous women with MS (wwMS) had a lower risk than nulliparous wwMS in reaching expanded disability disease status (EDSS) 4.0 and 6.0 [10,12,17]
Gathering information on pregnancy-related issues is of crucial importance for the counseling of wwMS
Summary
Multiple sclerosis (MS) is an immune-mediated disease that leads to demyelization and axonal loss in the central nervous system. Pregnancy was shown to influence MS disease activity, by a decrease in the relapse rate, especially during the third trimester. An increase in relapses within the first months postpartum leads the relapse rate to the pre-pregnancy baseline status [2,3,4,5]. An association between both pregnancy and a higher number of offspring with a decreased risk of MS conversion in women with a first demyelinating event was described [5]. Several theories were developed about the protective effects of pregnancy on MS disease activity and progression. The anti-inflammatory effects of sex hormones, such as estrogen and progesterone (increased during pregnancy, above all in the third trimester), could be responsible for the beneficial effects on MS [6,7,8,9]
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