Pregnancy Decision-Making in Women with Multiple Sclerosis

Background: It is well documented that relapse rates of MS decrease during pregnancy and then increase postpartum. Most physicians have discouraged the use of disease modifying therapies (DMTs) immediately prior to conception, during pregnancy, and while breastfeeding because of possible deleterious effects to the fetus. However, the evidence is inconclusive with respect to the effect of cessation of DMT use during pregnancy, and immediately postpartum, on disease progression.

Objectives: Our primary objective is to examine the effects of DMT exposure on relapse activity during the 12-24 month period preconception, during pregnancy and during the 12-24 month period postpartum.

Methods: The women in this study are part of a longitudinal observational follow-up derived from the clinical practices of the New York State Multiple Sclerosis Consortium (NYSMSC). Data collected include demographic information, clinical EDSS, relapse rate, MS type, DMT history and patient-reported outcomes. A specific questionnaire was distributed to approximately 623 women from the NYSMSC (as of October, 2015) to capture information about pregnancies, pregnancy outcomes, postpartum periods, breastfeeding and pregnancy decision-making associated with DMT use, as well as relapses, before, during and after pregnancy. Enrollment into this study is ongoing. We will analyze differences in most recent EDSS and relapse rates for DMT users and DMT naïve participants, as well as patient reported quality of life and activities of daily living.

Results: Responses were received from 386 participants (response rate=62%) to date.  Approximately 18% of women in our sample report pregnancies or pregnancy attempts following onset of their MS symptoms.  

We will conduct chi-square tests, independent samples t-tests, or Mann Whitney tests as appropriate, to examine the association between DMT use and EDSS, relapse rates and quality of life measures. General Linear Modeling will be conducted for multivariable analysis with adjustment for covariates. We will also qualitatively analyze our data to describe themes associated with pregnancy decision-making and MS.

Conclusions: As many patients with MS are young women of childbearing age, information about pregnancy for people with MS is critically important. These results will help to inform women with MS and their families about pregnancy decision-making issues associated with DMT use.