Pregnancy rates among women with multiple sclerosis (MS) increased from 2006 to 2014 while relapse rates declined during pregnancy. In addition, women with MS were less likely to take disease-modifying drugs just prior to and during pregnancy. These are the results of two retrospective studies of health insurance claims published in Neurology on September 28.
A few decades ago, women with multiple sclerosis (MS) were discouraged from getting pregnant. Experts feared pregnancy could make their disease worse. Several subsequent studies, including a large prospective study published in the New England Journal of Medicine in 1998, reported just the opposite: The rate of relapse decreased during pregnancy and increased after delivery.
To examine pregnancy rates and outcomes among women with and without MS, and to analyze relapse rates and MS treatment during pregnancy, researchers from Brigham and Women's Hospital in Boston analyzed records from a health claims database from January 2006 to June 2015 of both women with and without MS.
Researchers assessed MS relapse rates using previously published retrospective claims database evaluations, including MS-related hospitalization, MS-related emergency department (ED) visits, and MS-related outpatient visits with any corticosteroid prescription (IV or oral) within seven days of the visit.
Researchers evaluated relapse rates and reviewed pharmacy or medical claims for disease-modifying MS drugs in the year before pregnancy, the three individual trimesters of pregnancy, six weeks after pregnancy, and one year after pregnancy.
From 2006 to 2014, the rate of pregnancy among women with MS increased from 7.91 percent to 9.47 percent. Among women without MS, the rate decreased from 8.83 percent to 7.75 percent. Among women who had live births, those with MS were 31 years old on average versus 29 for women without MS.
After matching 2,115 women with MS with 2,115 women without MS in each cohort, researchers found that women with MS had higher rates of pregnancy complications, including premature labor (31.4 percent versus 27.4 percent); infection in pregnancy (13.3 percent versus 10.9 percent), maternal cardiovascular disease (3 percent versus 1.9 percent); anemia or acquired coagulation disorder (2.5 percent versus 1.3 percent), neurologic complications (1.6 percent versus 0.6 percent), and sexually transmitted diseases in pregnancy (0.4 percent versus 0 percent).
In addition, women with MS who had a live birth submitted claims at a higher rate for acquired damage to the fetus (27.8 percent versus 23.5 percent) and congenital fetal malformations (13.2 percent versus 10.3 percent) during labor and delivery compared to their counterparts.
Among 2,158 women with MS who had a pregnancy with a live birth, 20 percent took disease-modifying drugs the year before conceiving. That number dropped to 2 percent during the second trimester and rebounded to 25 percent nine to 12 months after delivery.
Meanwhile, the rate of MS relapse decreased during pregnancy then spiked during the six months after delivery before decreasing again six to 12 months after delivery.
The researchers concluded that accurate statistics on the pregnancy outcomes of women with MS should improve quality of care for those who are considering starting a family.