https://www.msif.

org/news/2016/09/11/consecutive-pregnancies-in-ms/

Consecutive
pregnancies in MS
Research shows no difference in disease activity in successive pregnancies
Last updated: 9th September 2016

The majority of women who have MS are diagnosed in their twenties and
thirties, at a time when they may be thinking about starting a family.
There have been many studies examining the impact of pregnancy on MS.
They all show that pregnancy appears to have a positive protective influence,
with relapse rates going down, especially during the third trimester (between
six and nine months). The reasons for this are not fully understood, but it is
thought that hormone levels play a role. However, in the first three months
after the baby is born, the risk of relapse rises. This is thought to occur as
hormones return to pre-pregnancy levels.
It remains unknown whether there is any association between the numbers of
relapses experienced if a woman has more than one pregnancy. If such a
relationship does exist, neurologists could provide informed advice to women
with MS after their first pregnancy.
This study looked at a group of 93 French and Italian women with MS who had
had two consecutive pregnancies. Researchers evaluated the risk of relapses

during pregnancy and in the first three months after delivery in both
pregnancies.
The results showed that there was no difference in the disease activity
between two pregnancies. There was also no difference between the rebound
attacks after the pregnancy, when researchers compared the first and second
pregnancies.
Therefore, the researchers suggest that, counseling of women with MS who
consider having a second baby should be the same as for the first one.
During counselling, doctors should advise on both protective effects of
pregnancy against relapses, and the increased chance of new relapses in the
first three months after the baby is born.
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History of multiple sclerosis in 2

successive pregnancies
A French and Italian cohort
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Amandine Benoit, MD,

Franoise Durand-Dubief, MD, PhD,
Maria-Pia Amato, MD, PhD,
Emilio Portaccio, MD,
Romain Casey, PhD,
Stphanie Roggerone, MD,
Graldine Androdias, MD,
Laurence Gignoux, MD,
Iuliana Ionescu, MD,
Maria-Giovanna Marrosu, MD,

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Eleonora Cocco, MD,

Angelo Ghezzi, MD,
Pietro Annovazzi, MD,
Maria Trojano, MD, PhD,
Marta Simone, MD,
Romain Marignier, MD, PhD,
Christian Confavreux, MD and
Sandra Vukusic, MD, PhD

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Correspondence to Dr. Vukusic: sandra.vukusic@chu-lyon.fr

Published online before print July 27, 2016, doi: http://dx.doi.org/10.1212/

WNL.0000000000003036Neurology 10.1212/WNL.0000000000003036

Abstract

Full Text (PDF)

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Also available:

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Accompanying Editorial

ABSTRACT
Objective: To evaluate the risk of relapses during pregnancy and in the first 3
months after delivery in 2 successive pregnancies in a cohort of French and
Italian women with multiple sclerosis (MS).
Methods: A total of 93 women were included if they had had 2 pregnancies
followed prospectively after MS onset between January 1993 and 2013. The
association of a relapse during pregnancy or the first postpartum trimester in
pregnancy 1 and pregnancy 2 was evaluated by univariate logistic regression.
Results: A majority of women did not experience any exacerbation in the 3
months after delivery (31.2% and 23.7%, respectively, relapsed after pregnancy
1 and 2; p = 0.32). A total of 7.6% had a relapse after both pregnancies. The risk
of relapse after pregnancy 2 was not associated with the number of relapses in
the prepregnancy year (odds ratio [OR] 1.52 [0.574.05]) or during pregnancy
(OR 1.57 [0.524.79]) or with the occurrence of a relapse after pregnancy 1 (OR
0.86 [0.292.50]).
Conclusions: Our work provides original data on the evolution of successive
pregnancies in MS, showing a similar (and even lower) disease activity in the
second pregnancy. There was no correlation of activity in successive

pregnancies. Therefore, counseling of women with MS who consider having a

second baby should be the same as for the first one.

FOOTNOTES

Deceased.

Received December 29, 2015.

Accepted in final form April 28, 2016.

2016 American Academy of Neurology