Analysis of the course of pregnancy, delivery and postpartum period in women with multiple sclerosis
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 1 <sup>st</sup> line DMT just before conception (p < 0.01) and multiple pregnancies (p < 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.