Successive pregnancies in multiple sclerosis

摘要

In this issue of Neurology (R), Benoit et al.(1) describe results of a multicenter collaborative study designed to identify the association between relapses in the periods before, during, and after 2 successive pregnancies in women with multiple sclerosis (MS). MS is the leading cause of chronic neurologic disability in young adults worldwide, and because it disproportionately affects women of childbearing age, issues associated with pregnancy are of great importance to patients and their health care providers. Pregnancy is accompanied by a reduction in annualized relapse rates (ARRs), followed by an increased risk for relapses in the postpartum period (reviewed in Vukusic and Marignier(2)). It is unlikely that MS hampers either fertility or pregnancy outcome(3,4) and hence multiple pregnancies among patients with MS is a common and often-desired scenario. Naturally, the potential for relapse after delivery is of concern to patients who wish to plan additional pregnancies. To evaluate MS disease activity in multiple pregnancies, Benoit and collaborators analyzed relapse data in a cohort of patients (n = 93) who had at least 2 successive pregnancies during a 10-year period from 1993 to 2013. Demographic, disease, and pregnancy-specific data were available from 1 French and 4 Italian MS centers participating in the European Database for Multiple Sclerosis (EDMUS; France) and the iMed database (Merck Serono-Geneva; Italy). As a possible control for disease severity, 68 French patients who had only 1 pregnancy during the study period were also included.