Department of Neurology, Nationaal MS Centrum, Melsbroek, Belgium.
J Neurol Neurosurg Psychiatry. 2010 Jan;81(1):38-41. doi: 10.1136/jnnp.2008.163816. Epub 2009 Nov 25.
The uncertainty about long-term effects of childbirth presents MS patients with dilemmas.
Based on clinical data of 330 female MS patients, the long-term effects of childbirth were analysed, using a cross-sectional study design. Four groups of patients were distinguished: (1) without children (n = 80), (2) with children born before MS onset (n = 170), (3) with children born after MS onset (n = 61) and (4) with children born before and after MS onset (n = 19). A time-to-event analysis and Cox proportional hazard regression were performed with time from onset to EDSS 6 and age at EDSS 6 as outcome measure.
After a mean disease duration of 18 years, 55% had reached EDSS 6. Survival curves show a distinct shift in the time to EDSS 6 between patients with no children after MS onset and patients with children after MS onset in favour of the latter. Cox regression analysis correcting for age at onset shows that patients with children only after MS onset had a reduced risk compared with patients without children (HR 0.61; 95% CI 0.37 to 0.99, p = 0.049). Also, patients who gave birth at any point in time had a reduced risk compared with patients without children (HR 0.66; 95% CI 0.47 to 0.95, p = 0.023). A similar pattern was seen for age at EDSS 6 (HR 0.57, p = 0.027 and HR 0.68, p = 0.032 respectively)
Although a bias cannot fully be excluded, these results seem to support a possible favourable long-term effect of childbirth on the course of MS.
分娩对长期影响的不确定性使 MS 患者面临两难选择。
基于 330 名女性 MS 患者的临床数据，采用横断面研究设计分析分娩的长期影响。将患者分为四组：（1）无子女组（n = 80）；（2）MS 发病前分娩子女组（n = 170）；（3）MS 发病后分娩子女组（n = 61）；（4）MS 发病前和发病后均分娩子女组（n = 19）。采用时间事件分析和 Cox 比例风险回归，以发病至 EDSS 6 的时间和 EDSS 6 时的年龄为结局指标。
在平均病程 18 年后，55%的患者达到 EDSS 6。生存曲线显示，在 MS 发病后无子女的患者和 MS 发病后有子女的患者中，EDSS 6 的时间有明显的差异，后者更有利。Cox 回归分析校正发病年龄后显示，仅在 MS 发病后分娩子女的患者与无子女的患者相比，风险降低（HR 0.61；95%CI 0.37 至 0.99，p = 0.049）。此外，任何时间分娩的患者与无子女的患者相比，风险降低（HR 0.66；95%CI 0.47 至 0.95，p = 0.023）。EDSS 6 年龄也呈现出类似的模式（HR 0.57，p = 0.027 和 HR 0.68，p = 0.032）。
尽管不能完全排除偏差，但这些结果似乎支持分娩对 MS 病程可能有有利的长期影响。
