From the Division of Neurology (R.A.), Department of Medicine, Amiri Hospital, Sharq; Department of Pharmacy Practice (M.S.A.), School of Pharmacy, Kuwait University, Jabriya; Department of Neurology (S.F.A., J.A.-H.), Ibn Sina Hospital, Sabah Medical Area, Kuwait; Department of Neurology and Psychiatry (S.F.A.), Minia University, Egypt; Department of Ophthalmology (R.B.), Al-Bahar Eye Center, Sabah Medical Area; and Department of Medicine (J.A.-H.), Faculty of Medicine, Kuwait University, Jabriya.
Neurology. 2018 Mar 6;90(10):e840-e846. doi: 10.1212/WNL.0000000000005065. Epub 2018 Feb 2.
To determine the rate of relapse occurrence during pregnancy and postpartum.
In a cross-sectional study using the national multiple sclerosis (MS) registry, pregnant women with relapsing MS were identified. Data on demographics, clinical characteristics, and disease-modifying therapies (DMTs), including washout periods, were collected. Timings and durations of relapses were extracted. A multivariate logistic regression was used to assess the relationship between relapses and prior use of different DMTs.
Completed data were available for 99 pregnancies (87 patients). Mean age and mean age at onset were 31.8 ± 5 and 24.4 ± 5.6 years, respectively, while the mean disease duration was 7.4 ± 4.6 years. Most pregnancies (89.9%) occurred in patients who were on DMTs in the year preceding pregnancy with a mean treatment duration of 63.4 ± 29 months. The rates of occurrence of relapses during pregnancy and postpartum were 17.2% and 13.7%, respectively. Most of the relapses occurred during the first (n = 6) and third (n = 7) trimesters. Rate of relapse was highest among patients receiving natalizumab and fingolimod before pregnancy. A longer washout period was significantly associated with relapse occurrence.
The relapse occurrence during pregnancy is higher than the previously published rates. The use of high-efficacy therapies with long washout periods before conception was associated with an increased risk of relapses during pregnancy. Postpartum relapse occurrence was similar to that in previous reports.
确定妊娠和产后复发的发生率。
在一项使用全国多发性硬化症（MS）登记处的横断面研究中，确定了患有复发性 MS 的孕妇。收集了人口统计学、临床特征和疾病修饰疗法（DMT）的数据，包括冲洗期。提取了复发的时间和持续时间。使用多变量逻辑回归来评估复发与先前使用不同 DMT 之间的关系。
完成的数据可用于 99 例妊娠（87 例患者）。平均年龄和发病时平均年龄分别为 31.8 ± 5 岁和 24.4 ± 5.6 岁，而平均病程为 7.4 ± 4.6 年。大多数妊娠（89.9%）发生在妊娠前一年接受 DMT 的患者中，平均治疗持续时间为 63.4 ± 29 个月。妊娠期间和产后的复发率分别为 17.2%和 13.7%。大多数复发发生在第一个（n = 6）和第三个（n = 7）妊娠三个月。在妊娠前接受那他珠单抗和芬戈莫德治疗的患者中，复发率最高。较长的冲洗期与复发的发生显著相关。
妊娠期间的复发发生率高于先前发表的比率。在受孕前使用高效治疗药物且冲洗期较长与妊娠期间复发风险增加相关。产后复发的发生率与先前的报告相似。
