Karp Igor, Manganas Alexandra, Sylvestre Marie-Pierre, Ho Annie, Roger Elaine, Duquette Pierre
Centre de recherche du Centre hospitalier de l'Université de Montréal, (CRCHUM), Montréal, Québec, Canada; Département de médecine sociale et préventive, Université de Montréal, Montréal, Québec, Canada.
Université de Montréal, Montréal, Québec, Canada.
Ann Epidemiol. 2014 Jul;24(7):504-8.e2. doi: 10.1016/j.annepidem.2014.04.007. Epub 2014 Apr 24.
The purpose was to examine the impact of pregnancy on the rates of relapses, progression to irreversible disability, and transition to secondary progressive multiple sclerosis (SPMS) in patients with relapsing-remitting multiple sclerosis (RRMS).
We retrospectively followed two subcohorts of women with RRMS: pregnant (n = 254) and nonpregnant (n = 423). We obtained data on demographic, lifestyle, and clinical characteristics from patient records. Poisson and logistic regressions estimated the rate ratios associated with pregnancy as a function of time. Confounding was controlled by propensity-score adjustment, and postbaseline selection bias was controlled by inverse probability weighting.
In the pregnant and nonpregnant subcohorts, respectively, 300 and 787 relapses, 15 and 27 transitions to SPMS, and 11 and 34 progressions to irreversible disability were documented. Adjusted rate ratios (95% confidence intervals) shortly after baseline were 0.67 (0.49; 0.92) for relapses, 0.16 (0.03; 0.79) for irreversible disability, and 1.25 (0.39; 3.96) for SPMS. The corresponding estimates at 5 and 10 years were, respectively, 1.04 (0.72; 1.52), 0.82 (0.36; 1.88), and 2.33 (1.03; 5.26) and 1.62 (0.84; 3.14), 4.14 (0.89; 19.22), and 4.33 (1.10; 16.99).
Pregnancy likely ameliorates the short-term course of RRMS in terms of the rates of relapses and progression to irreversible disability. Over the long term, it appears to have no material impact on these outcomes, and might in fact accelerate the rate of transition to SPMS.
本研究旨在探讨妊娠对复发缓解型多发性硬化症（RRMS）患者的复发率、进展为不可逆残疾的比率以及转变为继发进展型多发性硬化症（SPMS）的影响。
我们对两组RRMS女性患者进行了回顾性随访：妊娠组（n = 254）和非妊娠组（n = 423）。我们从患者记录中获取了人口统计学、生活方式和临床特征数据。泊松回归和逻辑回归估计了与妊娠相关的比率随时间的变化。通过倾向得分调整控制混杂因素，并通过逆概率加权控制基线后选择偏倚。
在妊娠组和非妊娠组中，分别记录了300次和787次复发、15例和27例转变为SPMS以及11例和34例进展为不可逆残疾。基线后不久的调整比率（95%置信区间），复发率为0.67（0.49；0.92），不可逆残疾率为0.16（0.03；0.79），SPMS为1.25（0.39；3.96）。5年和10年时的相应估计值分别为1.04（0.72；1.52）、0.82（0.36；1.88）和2.33（1.03；5.26）以及1.62（0.84；3.14）、4.14（0.89；19.22）和4.33（1.10；16.99）。
就复发率和进展为不可逆残疾的比率而言，妊娠可能改善RRMS的短期病程。从长期来看，它似乎对这些结果没有实质性影响，实际上可能会加速转变为SPMS的速度。
