Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Faculty of Medicine, Universidad de Zaragoza, Zaragoza, Spain.
J Comp Eff Res. 2021 Feb;10(3):175-186. doi: 10.2217/cer-2020-0211. Epub 2021 Feb 10.
Although previous cohort studies of women with multiple sclerosis (MS) yielded a reduction in relapse rate during pregnancy, the effect size has not been quantified in a comprehensive manner. In addition, the effects on disability progression and peripartum outcomes have been controversial. The purpose of this work is to assess the effect of pregnancy on disease activity, and to assess the effects of MS on pregnancy as well. We searched in PubMed, Cochrane Library and EMBASE for cohort studies dealing with the effects of pregnancy on relapse rates, disability progression and peripartum outcomes in women with MS. The evaluated outcomes were: changes in the annualized relapse rate (ARR) in pregnancy and puerperium, disability worsening compared with the year before pregnancy, and peripartum outcomes, which were compared with the ones of non-MS women. In the majority of cohorts included here, the women were not under disease modifying therapies during pregnancy. We found 23 cohort studies measuring changes in the ARR during pregnancy and puerperium; 12 were prospective and 11 retrospective. In 17 cohorts there was significant reduction in the ARR during pregnancy compared with prepregnancy period. The pooled mean reduction in the ARR was -0.5 (95% CI: 0.67-0.38), p < 0.001, from 15 cohorts included in meta-analysis. In 18 cohorts the ARR increased in the 3-month puerperium relative to prepregnancy year period; the pooled mean increase in the ARR was 0.22 (95% CI: 0.11-0.33), p < 0.001, from 14 cohorts included in meta-analysis. Disability worsening was addressed in 18 cohorts, and in 14 of them there were no significant changes. Peripartum complications and obstetrical outcomes were assessed in 16 cohorts, of whom 13 were retrospective, without finding significant differences. Pregnancy is associated with lower disease activity, and puerperium with higher disease activity. Disability does not change significantly after pregnancy. The obstetrical outcomes are not very different from those of non-MS women in most cohorts.
尽管之前针对多发性硬化症（MS）女性的队列研究表明妊娠期间复发率降低，但尚未全面量化其效应大小。此外，关于残疾进展和围产期结局的影响一直存在争议。本研究的目的是评估妊娠对疾病活动的影响，并评估 MS 对妊娠的影响。我们在 PubMed、Cochrane Library 和 EMBASE 中检索了关于妊娠对 MS 女性复发率、残疾进展和围产期结局影响的队列研究。评估的结局包括：妊娠和产褥期年化复发率（ARR）的变化、与妊娠前一年相比残疾恶化的情况，以及与非 MS 女性相比的围产期结局。在这里纳入的大多数队列中，女性在妊娠期间未接受疾病修正治疗。我们发现了 23 项衡量妊娠和产褥期期间 ARR 变化的队列研究；其中 12 项为前瞻性研究，11 项为回顾性研究。在 17 项队列研究中，妊娠期间 ARR 与妊娠前相比显著降低。纳入荟萃分析的 15 项队列的汇总平均 ARR 降低幅度为 -0.5（95% CI：0.67-0.38），p<0.001。18 项队列研究中，产后 3 个月的 ARR 相对妊娠前一年增加；纳入荟萃分析的 14 项队列的汇总平均 ARR 增加幅度为 0.22（95% CI：0.11-0.33），p<0.001。18 项队列研究中评估了残疾恶化情况，其中 14 项无显著变化。16 项队列研究评估了围产期并发症和产科结局，其中 13 项为回顾性研究，未发现显著差异。妊娠与疾病活动降低相关，产褥期与疾病活动增加相关。妊娠后残疾无明显变化。在大多数队列中，产科结局与非 MS 女性无显著差异。
