Multiple sclerosis (MS) most often affects women of childbearing age, making family planning and management of the disease before, during, and after pregnancy a primary concern for many patients. In 2 articles published in this week's issue of Neurology, analysis of data from an administrative claims database in the US provides a better understanding of the natural history of MS during pregnancy and the use of disease-modifying treatments (DMT) from the year before pregnancy through a year after giving birth.
Using the IQVIA Real-World Adjudicated Claims-US database, 2,158 women with MS who had a year of continuous insurance 1 year before and 1 year after having a live birth were identified. The continuity of insurance ensured continuity of data in the database.
Adjusted monthly relapse rates for all patients showed that the adjusted rate of relapse declined from 1.47 before pregnancy to a rate of 0.87-1.00 during pregnancy (odds ratio [OR] 0.623, 95% CI 0.521–0.744; P < .0001). The rate of relapse increased rapidly in the 6 weeks after giving birth to 2.56 (OR 1.710, 95% CI 1.358–2.152; P < .0001) and then declined to 1.76 at 1 year after giving birth, higher than the rate before pregnancy (OR 1.216, 95% CI 1.052–1.406; P = .0081).
Additionally, this analysis found that the number of women using DMT in the year before pregnancy was low (20.5%), declined further during pregnancy (12%, 1.9%, and 3% in trimester 1-3 respectively), and ended at a higher level (25.5%) 1 year after giving birth.
Data were also used to examine the rates of pregnancy in women with MS between 2006 and 2014 and estimate that the number of women with MS giving birth rose from 7.91% to 9.47% during this period. When matched to a control population of women without MS who gave birth during the same period, women with MS had higher rates of complications than women without MS: anemia/acquired coagulation disorders (2.5% vs 1.3%; P = .007), acquired fetal damage (27.8% vs 23.5%; P = .002), cardiovascular disease (3.0% vs 1.9%; P = .028), congenital fetal malformations (13.2% vs 10.3%; P = .004), infection (13.3% vs 10.9%; P = .016, premature labor (31.4% vs 27.4%; P = .005), neurologic complications (1.6% vs 0.6%; P = .005), and sexually transmitted diseases (0.4% vs 0.1%; P = .045).Next Story