D'Amico Emanuele, Leone Carmela, Patti Francesco
Department of Neurology, University of Catania, Multiple Sclerosis Center, Policlinico G. Rodolico, Via Santa Sofia, 78 Catania 95123, Italy.
Int J Mol Sci. 2016 Feb 12;17(2):234. doi: 10.3390/ijms17020234.
Data on pregnancy long-term effects on multiple sclerosis (MS) course are still controversial; whether experiencing more than one pregnancy exposes one to risk of the disability's accrual is still unknown. We investigated differences existing in terms of disability progression among women with MS (wwMS) who had one or more children after their MS onset.
Monoparous and multiparous wwMS were enrolled from the Catania MS Center, Italy, in a monocenter retrospective study. A Cox proportional hazards model was used to examine the effect of the number of parities on time from MS disease onset to EDSS 4.0 and 6.0. The study protocol was approved by the local Ethical Committee.
During the seven years of observation, 32.1% and 23.2% of the monoparous group reached expanded disability disease status (EDSS) 4.0 and 6.0 respectively, compared to 13.3% and 3.3% of the multiparous group (p = 0.057 and p = 0.017; respectively). The Kaplan-Meier curve analysis showed no statistically-significant differences between the two groups in reaching the two milestones. The multiparous group showed a longer time to reach the EDSS 4.0 (3.5 vs. 2.6 years, log-rank 0.57, p = 0.45). The Cox regression analysis showed that the EDSS at the time of first pregnancy (Exp(B) 9.4, CI 4.5-19.7, p< 0.001) and the time from MS onset to first pregnancy (Exp(B) 0.96, CI = 0.93-0.98, p < 0.05) were significant predictors of reaching the EDSS 4.0, whereas a model including only the EDSS one year after the first pregnancy significantly predicted (Exp(B) value of 6.4, CI 2.6-15.4, p < 0.001) the reaching of EDSS 6.0.
Our results suggest that experiencing more than one pregnancy could not convey a different clinical outcome in wwMS. Further research is needed to confirm our results.
关于妊娠对多发性硬化症（MS）病程的长期影响的数据仍存在争议；经历多次妊娠是否会使人面临残疾累积的风险仍不清楚。我们调查了MS发病后生育一个或多个孩子的MS女性（wwMS）在残疾进展方面存在的差异。
在意大利卡塔尼亚MS中心进行的一项单中心回顾性研究中，纳入了初产妇和经产妇wwMS。采用Cox比例风险模型来检验产次数量对从MS疾病发作到扩展残疾状态量表（EDSS）评分为4.0和6.0的时间的影响。该研究方案已获得当地伦理委员会的批准。
在七年的观察期内，初产妇组分别有32.1%和23.2%的患者达到EDSS 4.0和6.0，而经产妇组分别为13.3%和3.3%（p分别为0.057和0.017）。Kaplan-Meier曲线分析显示，两组在达到这两个里程碑方面无统计学显著差异。经产妇组达到EDSS 4.0的时间更长（3.5年对2.6年，对数秩检验为0.57，p = 0.45）。Cox回归分析表明，首次妊娠时的EDSS（风险比（Exp(B)）9.4，置信区间（CI）4.5 - 19.7，p < 0.001）以及从MS发病到首次妊娠的时间（Exp(B) 0.96，CI = 0.93 - 0.98，p < 0.05）是达到EDSS 4.0的显著预测因素，而仅包含首次妊娠后一年EDSS的模型显著预测了达到EDSS 6.0（Exp(B)值为6.4，CI 2.6 - 15.4，p < 0.001）。
我们的结果表明，经历多次妊娠在wwMS中可能不会带来不同的临床结果。需要进一步的研究来证实我们的结果。
