Lorefice Lorena, Fronza Marzia, Fenu Giuseppe, Frau Jessica, Coghe Giancarlo, D'Alterio Maurizio Nicola, Barracciu Maria Antonietta, Murgia Federica, Angioni Stefano, Cocco Eleonora
Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, University of Cagliari, Via Is Guadazzonis 2, 09126, Cagliari, Italy.
Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
Neurol Ther. 2022 Mar;11(1):39-49. doi: 10.1007/s40120-021-00297-6. Epub 2021 Oct 29.
Pregnancy represents an important event for women with multiple sclerosis (MS) and is often accompanied by post-partum disease reactivation. To date, the influence of this reproductive phase on long-term MS outcomes is still largely unexplored. The objective of the study was characterise a large real-world cohort of women with MS to evaluate the effects of pregnancy and breastfeeding on short- and long-term clinical and magnetic resonance imaging (MRI) outcomes while exploring the relationships with MRI measurements of brain atrophy.
MS patients with and without pregnancy were recruited. Clinical relapses and MRI activity of the year before conception versus the year after delivery were evaluated. Regression models were performed to investigate the relationships between long-term MS outcomes (EDSS score and MRI brain measurements obtained by SIENAX software) and pregnancy and breastfeeding duration.
Two hundred ten women with MS were enrolled; of them, 129 (61.4%) had at least one pregnancy. Of all pregnancies (n = 212), those that occurred after MS onset (90 [42.4%]) were examined to evaluate the short-term outcomes. A higher annualised relapse rate in the post-partum year versus the pre-conception year (0.54 ± 0.84 vs. 0.45 ± 0.71; p = 0.04) was observed. A regression analysis showed that clinical activity after delivery was associated with clinical activity of the year before conception (p = 0.001) as well as duration of breastfeeding (p = 0.022). Similarly, post-partum MRI activity was associated with pre-conception MRI activity (p = 0.026) and shorter breastfeeding duration (p = 0.013). Regarding long-term outcomes, having had at least one pregnancy during MS was associated with a lower EDSS score (p = 0.021), while no relationships were reported with MRI measurements. Conversely, a breastfeeding duration > 6 months was associated with lower white matter volume (p = 0.008).
Our study underlines the importance of considering the effects of pregnancy and breastfeeding on short- and long-term MS outcomes. In the current therapeutic landscape, pregnancy planning and treatment optimisation in the post-partum period, in particular for women who choose to breastfeed, are fundamental for the management of these biological phases so central in a woman's life.
怀孕对患有多发性硬化症（MS）的女性来说是一个重要事件，且往往伴随着产后疾病复发。迄今为止，这个生殖阶段对MS长期预后的影响在很大程度上仍未得到充分探索。本研究的目的是对一大群患有MS的女性进行真实世界队列研究，以评估怀孕和母乳喂养对短期和长期临床及磁共振成像（MRI）结果的影响，同时探索与脑萎缩MRI测量值之间的关系。
招募了有怀孕和无怀孕的MS患者。评估了受孕前一年与分娩后一年的临床复发情况和MRI活动。进行回归模型分析，以研究MS长期预后（扩展残疾状态量表[EDSS]评分和通过SIENAX软件获得的脑部MRI测量值）与怀孕及母乳喂养持续时间之间的关系。
共纳入210名患有MS的女性；其中，129名（61.4%）至少有过一次怀孕。在所有怀孕（n = 212次）中，对MS发病后发生的怀孕（90次[42.4%]）进行了检查，以评估短期结果。观察到产后一年的年化复发率高于受孕前一年（0.54±0.84对0.45±0.71；p = 0.04）。回归分析表明，分娩后的临床活动与受孕前一年的临床活动相关（p = 0.001）以及与母乳喂养持续时间相关（p = 0.022）。同样，产后MRI活动与受孕前MRI活动相关（p = 0.026）以及与较短的母乳喂养持续时间相关（p = 0.013）。关于长期结果，在MS期间至少有过一次怀孕与较低的EDSS评分相关（p = 0.021），而未发现与MRI测量值有相关性。相反，母乳喂养持续时间>6个月与较低的白质体积相关（p = 0.008）。
我们的研究强调了考虑怀孕和母乳喂养对MS短期和长期结果影响的重要性。在当前的治疗背景下，怀孕计划和产后治疗优化，特别是对于选择母乳喂养的女性，对于管理这些在女性生活中如此关键的生理阶段至关重要。
