BACKGROUND: The impact of pregnancy on disease outcomes has not been characterised in women with progressive multiple sclerosis (MS) phenotypes. This study aimed to describe the clinical characteristics and disease course of women who experienced a pregnancy after a diagnosis of primary progressive MS (PPMS) or secondary progressive MS (SPMS). METHODS: This multicentre observational cohort study utilised data from the international MSBase Registry extracted on 2 June 2024. Expanded Disability Status Scale (EDSS) scores of women with progressive MS were assessed up to 10 years postpartum and compared to those of propensity score-matched women with progressive MS without a pregnancy history. RESULTS: In total, 138 women with 164 pregnancies were included in the study, comprising 75 women with PPMS and 63 with SPMS. Of these, 24 women with PPMS and 47 with SPMS had longitudinal peri-pregnancy EDSS assessments and were included in the analysis of disability scores. A history of pregnancy was not associated with a significant difference in long-term disability trajectories in women with either PPMS (estimate = -0.02; 95% confidence interval (CI) = -0.07 to 0.04) or SPMS (estimate = 0.00; 95% CI = -0.02 to 0.03). CONCLUSION: A history of pregnancy is not associated with a significant difference in long-term disability in women with progressive MS symptoms.

Brain and Mind Centre The University of Sydney Sydney NSW Australia

Centre for Rehabilitation Disability and Sport Medicine Department of Neurosciences Imaging and Clinical Sciences Chieti Italy

Centre hospitalier de l'Université de Montréal Université de Montréal Montreal QC Canada

CORe Department of Medicine The University of Melbourne Melbourne VIC Australia

Department of Medical and Surgical Sciences and Advanced Technologies G F Ingrassia Catania Italy

Department of Neurology Alfred Health Melbourne VIC Australia

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Neurology Box Hill Hospital Melbourne VIC Australia

Department of Neurology Dr Etemadifar MS Institute Isfahan University of Medical Sciences Isfahan Iran

Department of Neurology Hospital Universitario Virgen Macarena Seville Spain

Department of Neurology Medical Faculty Karadeniz Technical University Trabzon Turkey

Department of Neurology School of Medicine and Koç University Research Center for Translational Medicine Koç University School of Medicine Istanbul Turkey

Department of Neuroscience School of Translational Medicine Monash University Melbourne VIC Australia

Department of Neurosciences Eastern Health Clinical School Monash University Melbourne VIC Australia

Dipartimento di Scienze Biomedieche e Neuromotorie Università di Bologna Bologna Italia

Division of Neurology Department of Medicine Amiri Hospital Sharq Kuwait

Institute for Advanced Biomedical Technologies Department of Neurosciences Imaging and Clinical Sciences University G d'Annunzio of Chieti Pescara Chieti Italy

IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italia

Izmir University of Economics Medical Point Hospital Izmir Turkey

MS Centre Clinical Neurology SS Annunziata University Hospital Chieti Italy

Multiple Sclerosis Research Association Izmir Turkey

Multiple Sclerosis Unit AOU Policlinico G Rodolico San Marco University of Catania Catania Italy

Neuroimmunology Centre Department of Neurology Royal Melbourne Hospital Melbourne VIC Australia

Zobrazit více v PubMed

Kuhlmann T, Moccia M, Coetzee T, et al. Multiple sclerosis progression: Time for a new mechanism-driven framework. Lancet Neurol 2023; 22(1): 78–88. PubMed PMC

Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis. Neurology 2014; 83(3): 278–286. PubMed PMC

Krysko KM, Graves JS, Dobson R, et al. Sex effects across the lifespan in women with multiple sclerosis. Ther Adv Neurol Disord 2020; 13: 936166. PubMed PMC

Portaccio E, Magyari M, Havrdova EK, et al. Multiple sclerosis: Emerging epidemiological trends and redefining the clinical course. Lancet Reg Health Eur 2024; 44: 100977. PubMed PMC

Ziemssen T, Bhan V, Chataway J, et al. Secondary progressive multiple sclerosis: A review of clinical characteristics, definition, prognostic tools, and disease-modifying therapies. Neurol Neuroimmunol Neuroinflamm 2023; 10(1): e200064. PubMed PMC

Andersson PB, Waubant E, Gee L, et al. Multiple sclerosis that is progressive from the time of onset. Arch Neurol 1999; 56(9): 1138–1142. PubMed

Kalincik T, Vivek V, Jokubaitis V, et al. Sex as a determinant of relapse incidence and progressive course of multiple sclerosis. Brain 2013; 136(Pt. 12): 3609–3617. PubMed

Coyle PK. Management of women with multiple sclerosis through pregnancy and after childbirth. Ther Adv Neurol Disord 2016; 9(3): 198–210. PubMed PMC

Dobson R, Jokubaitis VG, Giovannoni G. Change in pregnancy-associated multiple sclerosis relapse rates over time: A meta-analysis. Mult Scler Relat Disord 2020; 44: 102241. PubMed

Schubert C, Steinberg L, Peper J, et al. Postpartum relapse risk in multiple sclerosis: A systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2023; 94(9): 718–725. PubMed

Vukusic S, Hutchinson M, Hours M, et al. Pregnancy and multiple sclerosis (the PRIMS study): Clinical predictors of post-partum relapse. Brain 2004; 127(Pt6): 1353–1360. PubMed

Anderson A, Krysko KM, Rutatangwa A, et al. Clinical and radiologic disease activity in pregnancy and postpartum in MS. Neurol Neuroimmunol Neuroinflamm 2021; 8(2): e959. PubMed PMC

Gavoille A, Rollot F, Casey R, et al. Investigating the long-term effect of pregnancy on the course of multiple sclerosis using causal inference. Neurology 2023; 100(12): e1296–e1308. PubMed PMC

Hughes SE, Spelman T, Gray OM, et al. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler 2014; 20(6): 739–746. PubMed

D’Amico E, Leone C, Patti F. Offspring number does not influence reaching the disability’s milestones in multiple sclerosis: A seven-year follow-up study. Int J Mol Sci 2016; 17(2): 234. PubMed PMC

Cuello JP, Martínez Ginés ML, Martin Barriga ML, et al. Multiple sclerosis and pregnancy: A single-centre prospective comparative study. Neurologia 2017; 32(2): 92–98. PubMed

Koch M, Uyttenboogaart M, Heersema D, et al. Parity and secondary progression in multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80(6): 676–678. PubMed

Achiron A, Ben-David A, Gurevich M, et al. Parity and disability progression in relapsing-remitting multiple sclerosis. J Neurol 2020; 267(12): 3753–3762. PubMed

Jokubaitis VG, Spelman T, Kalincik T, et al. Predictors of long-term disability accrual in relapse-onset multiple sclerosis. Ann Neurol 2016; 80(1): 89–100. PubMed

Keyhanian K, Davoudi V, Etemadifar M, et al. Better prognosis of multiple sclerosis in patients who experienced a full-term pregnancy. Eur Neurol 2012; 68(3): 150–155. PubMed

Zeydan B, Atkinson EJ, Weis DM, et al. Reproductive history and progressive multiple sclerosis risk in women. Brain Commun 2020; 2(2): fcaa185. PubMed PMC

Karp I, Manganas A, Sylvestre MP, et al. Does pregnancy alter the long-term course of multiple sclerosis. Ann Epidemiol 2014; 24(7): 504–508. PubMed

Ostrem BL, Anderson A, Conway S, et al. Peripartum disease activity in moderately and severely disabled women with multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8(2): 104918. PubMed PMC

D’hooghe MB, Haentjens P, Nagels G, et al. Menarche, oral contraceptives, pregnancy and progression of disability in relapsing onset and progressive onset multiple sclerosis. J Neurol 2012; 259(5): 855–861. PubMed

Ramagopalan S, Yee I, Byrnes J, et al. Term pregnancies and the clinical characteristics of multiple sclerosis: A population based study. J Neurol Neurosurg Psychiatry 2012; 83(8): 793–795. PubMed

Butzkueven H, Chapman J, Cristiano E, et al. MSBase: An international, online registry and platform for collaborative outcomes research in multiple sclerosis. Mult Scler 2006; 12(6): 769–774. PubMed

Montalban X, Hauser SL, Kappos L, et al. Ocrelizumab versus placebo in primary progressive multiple sclerosis. N Engl J Med 2017; 376(3): 209–220. PubMed

Forsberg L, Spelman T, Klyve P, et al. Proportion and characteristics of secondary progressive multiple sclerosis in five European registries using objective classifiers. Mult Scler J Exp Transl Clin 2023; 9(1): 153557. PubMed PMC

Sharmin S, Roos I, Simpson-Yap S, et al. The risk of secondary progressive multiple sclerosis is geographically determined but modifiable. Brain 2023; 146(11): 4633–4644. PubMed PMC

Lublin FD, Häring DA, Ganjgahi H, et al. How patients with multiple sclerosis acquire disability. Brain 2022; 145(9): 3147–3161. PubMed PMC

Müller J, Cagol A, Lorscheider J, et al. Harmonizing definitions for progression independent of relapse activity in multiple sclerosis. JAMA Neurol 2023; 80(11): 1232. PubMed

Yeh WZ, Widyastuti PA, Van der Walt A, et al. Natalizumab, fingolimod, and dimethyl fumarate use and pregnancy-related relapse and disability in women with multiple sclerosis. Neurology 2021; 96(24): e2989–e3002. PubMed PMC

Paz Soldán MM, Novotna M, Abou Zeid N, et al. Relapses and disability accumulation in progressive multiple sclerosis. Neurology 2015; 84(1): 81–88. PubMed PMC

Pitt D, Lo CH, Gauthier SA, et al. Toward precision phenotyping of multiple sclerosis. Neurol Neuroimmunol Neuroinflamm 2022; 9(6): e200025. PubMed PMC

Cree BAC, Arnold DL, Chataway J, et al. Secondary progressive multiple sclerosis: New insights. Neurology 2021; 97(8): 378–388. PubMed PMC