Predictors and dynamics of postpartum relapses in women with multiple sclerosis

2013 ◽  
Vol 20 (6) ◽  
pp. 739-746 ◽  
Author(s):  
Stella E Hughes ◽  
Tim Spelman ◽  
Orla M Gray ◽  
Cavit Boz ◽  
Maria Trojano ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Favourable Effect ◽  
Multivariable Model ◽  
Third Trimester ◽  
Relapse Risk ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Disability Status ◽  
Disease Modifying Treatment ◽  
Control Study

Background: Several studies have shown that pregnancy reduces multiple sclerosis (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 postpartum 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 postpartum relapse risk in women with MS planning pregnancy.

Serum anti-Müllerian hormone levels in reproductive-age women with relapsing–remitting multiple sclerosis

2014 ◽  
Vol 21 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Jan Thöne ◽  
Susanne Kollar ◽  
Darryl Nousome ◽  
Gisa Ellrichmann ◽  
Ingo Kleiter ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Ovarian Reserve ◽  
Ovarian Function ◽  
Reproductive Age ◽  
Unexpected Finding ◽  
Healthy Controls ◽  
Relapsing Remitting ◽  
Disease Modifying Treatment ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Control Study

Background: Fertility might be reduced in women with multiple sclerosis (MS), although only few studies exist and the underlying reasons are not well understood. Similar to other autoimmune diseases, a decreased ovarian reserve may contribute to impaired fertility in women with MS. Anti-Müllerian hormone (AMH) is an established marker of the ovarian reserve and an objective indicator of ovarian function, which is independent of the hypothalamus-pituitary-gonadal axis function. Objective: The purpose of this study was to determine AMH levels in females with relapsing–remitting MS (RRMS) in combination with other reproduction and lifestyle factors. Methods: A total of 76 reproductive-age females with RRMS and 58 healthy controls were included in this case control study. An enzymatically amplified two-site immunoassay was used to measure serum AMH level. Results: Mean AMH level was significantly decreased in females with RRMS ( p<0.04), and a higher proportion of females with RRMS showed very low AMH values (<0.4 ng/ml) compared to healthy controls ( p<0.05). The majority of these women were currently without any disease modifying treatment. Conclusions: Our data contribute to our understanding of impaired fertility in women with MS. The unexpected finding that the majority of MS subjects with very low AMH levels were currently without medication requires further evaluation.

scholarly journals Natalizumab, Fingolimod and Dimethyl Fumarate Use and Pregnancy-Related Relapse and Disability in Women With Multiple Sclerosis

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012084
Author(s):  
Wei Zhen Yeh ◽  
Putu Ayu Widyastuti ◽  
Anneke Van der Walt ◽  
Jim Stankovich ◽  
Eva Havrdova ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cox Regression ◽  
Dimethyl Fumarate ◽  
Disability Progression ◽  
Third Trimester ◽  
Early Postpartum ◽  
Pregnancy And Postpartum ◽  
Relapsing Remitting ◽  
Effective Option ◽  
Using Data

Objective:To investigate pregnancy-related disease activity in a contemporary multiple sclerosis (MS) cohort.Methods:Using data from the MSBase Registry, we included pregnancies conceived after 31 Dec 2010 from women with relapsing-remitting MS or clinically isolated syndrome. Predictors of intrapartum relapse, and postpartum relapse and disability progression were determined by clustered logistic regression or Cox regression analyses.Results:We included 1998 pregnancies from 1619 women with MS. Preconception annualized relapse rate (ARR) was 0.29 (95% CI 0.27-0.32), fell to 0.19 (0.14-0.24) in third trimester, and increased to 0.59 (0.51-0.67) in early postpartum. Among women who used fingolimod or natalizumab, ARR before pregnancy was 0.37 (0.28-0.49) and 0.29 (0.22-0.37), respectively, and increased during pregnancy. Intrapartum ARR decreased with preconception dimethyl fumarate use. ARR spiked after delivery across all DMT groups. Natalizumab continuation into pregnancy reduced the odds of relapse during pregnancy (OR 0.76 per month [0.60-0.95], p=0.017). DMT re-initiation with natalizumab protected against postpartum relapse (HR 0.11 [0.04-0.32], p<0.0001). Breastfeeding women were less likely to relapse (HR 0.61 [0.41-0.91], p=0.016). 5.6% of pregnancies were followed by confirmed disability progression, predicted by higher relapse activity in pregnancy and postpartum.Conclusion:Intrapartum and postpartum relapse probabilities increased among women with MS after natalizumab or fingolimod cessation. In women considered to be at high relapse risk, use of natalizumab before pregnancy and continued up to 34 weeks gestation, with early re-initiation after delivery is an effective option to minimize relapse risks. Strategies of DMT use have to be balanced against potential fetal/neonatal complications.

scholarly journals Outcomes of pregnancy in Egyptian women with multiple sclerosis in the new treatment era: a multi-center retrospective observational study

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Ali Mahmoud Ahmed ◽  
Mohamed Al-Bahay M. G. Reda ◽  
Ahmed Hassan Elsheshiny
Keyword(s):  
Multiple Sclerosis ◽  
Observational Study ◽  
Exclusive Breastfeeding ◽  
Retrospective Observational Study ◽  
Third Trimester ◽  
Early Postpartum ◽  
Egyptian Women ◽  
History Of ◽  
New Treatment ◽  
The Relationship

Abstract Background Pregnancy is a recent growing issue in multiple sclerosis (MS) and the update in the diagnostic criteria of MS and introduction of many disease-modifying therapies (DMTs) may cause changes in the relationship between MS, pregnancy, and breastfeeding. This study aimed to investigate the effect of pregnancy and breastfeeding on MS and vice versa. A retrospective observational study was conducted to include MS women with a history of at least one pregnancy during the last 7 years. Data were collected from the archived files in addition to a self-administrating questionnaire. The annualized relapsing rate (ARR) was calculated before, during, and after pregnancy. Results We included 116 successful pregnancies from 93 MS women with mean age 32.74 ± 5.12 years. Interferon-beta was the commonly used DMT during and after pregnancy. Despite the ARR during the two years preceding the conception was 0.36 (95% CI 0.32–0.41), this rate was significantly decreased during first, second, and third trimester (0.07; 95% CI 0.04–0.15, 0.10; 95% CI 0.03–0.17, and 0.15; 95% CI 0.08–0.24, respectively; P-value < 0.001 in all). Furthermore, this ARR was significantly decreased during the first and last three months after delivery (0.27; 95% CI 0.16–0.39; P-value = 0.037, and 0.24; 95% CI 0.17–0.38; P-value = 0.023). Exclusive breastfeeding was associated with deceased risk of postpartum relapse, with HR 0.31 (95% CI 0.12–0.67; P = 0.002). Conclusions Pregnancy is protective from MS relapse, with a significant decrease of ARR from the pre-pregnancy period. Postpartum reactivation of the disease occurs from the third month after labor, rather than the early postpartum period. Exclusive breastfeeding for at least 2 months decreased the risk of postpartum relapse.

scholarly journals Migraine and frequent tension-type headache are not associated with multiple sclerosis in a Norwegian case-control study

2016 ◽  
Vol 2 ◽  
pp. 205521731668297 ◽  
Author(s):  
MW Gustavsen ◽  
EG Celius ◽  
BS Winsvold ◽  
SM Moen ◽  
GO Nygaard ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Case Control Study ◽  
Case Control ◽  
Tension Type Headache ◽  
Expanded Disability Status Scale ◽  
Disability Status ◽  
Type Headache ◽  
One Year ◽  
The One ◽  
Control Study

Background Inconsistent results have been obtained with regard to headache comorbidity in multiple sclerosis (MS). Objective Investigate the one-year prevalence of migraine and tension-type headache (TTH) in Norwegian MS patients and relate this to clinical parameters. Methods A questionnaire concerning headache was administered to 756 MS patients and 1090 controls and used to determine the one-year prevalence of migraine and frequent TTH. Results No significant differences were seen between patients and controls or between patients with different disease course. Less migraine was observed in patients with Expanded Disability Status Scale score (EDSS) ≥4.0. Conclusions This case-control study does not support an association between migraine or TTH and MS.

Clinical follow-up of 304 patients with multiple sclerosis three years after mitoxantrone treatment

2007 ◽  
Vol 13 (5) ◽  
pp. 626-631 ◽  
Author(s):  
M. Debouverie ◽  
L. Taillandier ◽  
S. Pittion-Vouyovitch ◽  
S. Louis ◽  
H. Vespignani
Keyword(s):  
Multiple Sclerosis ◽  
Interferon Beta ◽  
Progressive Multiple Sclerosis ◽  
Expanded Disability Status Scale ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Before And After ◽  
The Mean ◽  
Disease Modifying Treatment

The objectives of this study were to assess the benefits of 1) mitoxantrone after three years of follow-up and 2) disease-modifying treatment (DMT) after stopping mitoxantrone. A retrospective analysis was performed on 304 patients with active relapsing-remitting (RR) or progressive multiple sclerosis (PMS) who were treated with mitoxantrone. After mitoxantrone therapy, some patients received DMT (interferon-beta or glatiramer acetate) while others did not. The disease course of the two groups was evaluated by the Expanded Disability Status Scale (EDSS) before and after mitoxantrone and then every year for three years. The mean EDSS score at starting mitoxantrone and three years after stopping mitoxantrone respectively, were: 3.3 (1.3) and 3.2 (1.7) for the RRMS patients and 5.9 (1.2) and 6.4 (1.4) for the PMS patients. Before starting mitoxantrone, demographic and clinical parameters of predictive disability were not significantly different between patients who received DMT or not. The variation of EDSS between time of stopping mitoxantrone and three years later was significantly different (+0.9 versus +0.3; P=0.03) for patients with RRMS. We found that mitoxantrone treatment induces stable disease up to two years after discontinuation of mitoxantrone therapy. In the third year, patients without DMT deteriorated. Multiple Sclerosis 2007; 13: 626-631. http://msj.sagepub.com

scholarly journals Relation of Helicobacter pylori infection and multiple sclerosis in Iranian patients

2013 ◽  
Vol 5 (2) ◽  
pp. 10 ◽  
Author(s):  
Nafiseh Mohebi ◽  
Mansoureh Mamarabadi ◽  
Mehdi Moghaddasi
Keyword(s):  
Multiple Sclerosis ◽  
Helicobacter Pylori ◽  
Case Control Study ◽  
Demyelinating Disease ◽  
Protective Effects ◽  
Chronic Infections ◽  
Significant Difference ◽  
Disability Status ◽  
Ms Pathogenesis ◽  
Control Study

Multiple sclerosis (MS) is the most prevalent central nervous system demyelinating disease. There are known risk factors for MS. However, there is uncertainty in its protective factors. Few studies have demonstrated that some chronic infections may have protective effects on this disease. We carried this study to investigate the relation between <em>Helicobacter pylori </em>(HP) infection and the prevalence and severity of MS. In this case-control study, 163 MS patients and 150 sex- and age- matched controls were included. Blood samples for IgG and IgM anti HP antibodies were collected from all individuals. Also, the Expanded Disability Status Scale (EDSS) was used to evaluate the MS patients. Suitable statistical analysis was applied. A Significant difference was observed in seropositivity between these two groups (P&lt;0.001) but no significant difference was seen in seropositivity between conventional and opticospinal MS (P=0.522). No significant difference was observed in seropositivity among ages (P=0.075) and between genders (P=0.204). A significant difference was seen in EDSS value between seropositive and seronegative patients (P=0.017). We concluded that patients with HP infection had lower incidence of multiple sclerosis and MS patients with HP infection showed lower neurologic complications, which can demonstrate that HP infection may have a protective influence on MS pathogenesis.

scholarly journals Serum levels of leptin and adiponectin in patients with multiple sclerosis

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Rasha M. Fahmi ◽  
Amr E. Kamel ◽  
Dorreya A. Elsayed ◽  
Amal A. Zidan ◽  
Noha T. Sarhan
Keyword(s):  
Multiple Sclerosis ◽  
Potential Role ◽  
Case Control Study ◽  
Serum Levels ◽  
Serum Leptin ◽  
Disability Status ◽  
Egyptian Patients ◽  
Disability Severity ◽  
Control Study

Abstract Background The role of adipokines such as leptin and adiponectin in regulating the immunity has been documented, however data concerning their consequence on multiple sclerosis (MS) Egyptian patients are deficient. The aim of this study is to demonstrate the serum levels of leptin and adiponectin in MS patients and to assess their association with disease disability and severity. A case–control study including 60 subjects (30 MS patients and 30 age, sex and body mass index-matched healthy controls) was performed. Results Serum leptin level was significantly higher among MS patients than controls (P < 0.001) while adiponectin was not significantly elevated in MS patients (P = 0.24). There was a significant positive correlation between leptin levels with MS disability (Expanded Disability Status Scale) (r = 0.678; P < 0.001), severity (Multiple Sclerosis Severity Score) (r = 0.631; P < 0.001) and progression (progression index) (r = 0.461; P = 0.01). There was no statistically significant correlation between adiponectin with disease disability, severity or progression. Conclusions MS patients had significantly higher serum leptin levels and insignificant adiponectin levels compared to controls. Leptin has a potential role in multiple sclerosis disability and severity. However, adiponectin is not useful as a biomarker of MS disease, disability and severity.

scholarly journals Acute Fatty Liver of Pregnancy

2006 ◽  
Vol 20 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Hin Hin Ko ◽  
Eric Yoshida
Keyword(s):  
Fatty Liver ◽  
Acid Metabolism ◽  
Third Trimester ◽  
Fatal Complication ◽  
The Third ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Imaging Results ◽  
Acute Fatty Liver ◽  
Cholestasis Of Pregnancy

Acute fatty liver of pregnancy (AFLP) is a rare, potentially fatal complication that occurs in the third trimester or early postpartum period. Although the exact pathogenesis is unknown, this disease has been linked to an abnormality in fetal fatty acid metabolism. Early diagnosis of AFLP sometimes can be difficult because it shares features with other common conditions such as pre-eclampsia, viral hepatitis and cholestasis of pregnancy. However, a careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. Supportive care and expeditious delivery are essential to optimal maternal-fetal outcomes and remain as the mainstay treatment for AFLP.

scholarly journals Pregnancy and multiple sclerosis in the DMT era: A cohort study in Western Austria

2018 ◽  
Vol 26 (1) ◽  
pp. 69-78 ◽  
Author(s):  
Gabriel Bsteh ◽  
Laura Algrang ◽  
Harald Hegen ◽  
Michael Auer ◽  
Sebastian Wurth ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Binary Logistic Regression ◽  
Disability Progression ◽  
Early Postpartum ◽  
Child Bearing ◽  
Pregnancy And Postpartum ◽  
Standardized Treatment ◽  
Disease Modifying ◽  
Personalized Approach ◽  
Disease Modifying Treatment

Background: Multiple sclerosis (MS) predominantly affects women of child-bearing potential. Pregnancy in MS is still a controversial issue lacking standardized treatment recommendations. Objective: To examine the reciprocal effects of pregnancy, MS, and disease-modifying treatment (DMT). Methods: We analyzed 387 pregnancies in 239 women with relapsing remitting multiple sclerosis (RRMS) and ⩾1 pregnancy, establishment of diagnosis >1 year before conception, and ⩾2 years of follow-up after delivery. Relapse rates and Expanded Disability Status Scale (EDSS) scores were compared in the year before conception, during pregnancy, and 2 years postpartum. Binary logistic regression was used to investigate predictors of risk for relapses and disability progression during pregnancy and postpartum. Results: Risk of relapse and disability progression during pregnancy was predicted by pre-conception relapse activity, higher EDSS score at conception, use of highly effective disease-modifying treatment (H-DMT) pre-conception, and prolonged washout period. Postpartum relapse and disability progression was associated with relapse activity pre-conception and during pregnancy and use of H-DMT pre-conception. Early restart of DMT reduced the risk of postpartum relapse. Conclusion: A personalized approach in planning pregnancy in women with MS while on H-DMT needs to be adopted. It seems reasonable maintaining natalizumab closer to conception and restarting the drug early postpartum to reduce the considerable risk of disease reactivation during early pregnancy and after delivery.

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