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BMC Neurology

, 12:165

Demyelinating diseases

Abstract

BackgroundFew studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women with Multiple Sclerosis MS.

The objective of this study was to assess the impact of epidural analgesia EA and caesarean delivery CD on the risk of post-partum relapses and disability in women with MS.

MethodsIn the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery vaginal or caesarean and EA. The risk of post-partum relapses and disability progression 1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months was assessed through a logistic multivariate regression analysis.

ResultsWe collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year mean follow-up period 5.5±3.1 years. One hundred and fifty-five patients 44.4% underwent CD and 65 18.5% EA. In the multivariate analysis neither CD, nor EA were associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception OR=1.42; 95% CI 1.11-1.82; p=0.005, a higher number of relapses in the year before pregnancy OR=1.62; 95% CI 1.15-2.29; p=0.006 and during pregnancy OR=3.07; 95% CI 1.40-6.72; p=0.005. Likewise, CD and EA were not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery disability progression in the year after delivery: OR= 4.00; 95% CI 2.0-8.2; p<0.001; disability progression over the whole follow-up period: OR= 2.0; 95% CI 1.2-3.3; p=0.005.

ConclusionsOur findings, show no correlation between EA, CD and postpartum relapses and disability. Therefore these procedures can safely be applied in MS patients. On the other hand, post-partum relapses are significantly associated with increased disability, which calls for the need of preventive therapies after delivery.

KeywordsEpidural analgesia Caesarean delivery Multiple sclerosis Pregnancy AbbreviationsMSMultiple sclerosis

EAEpidural analgesia

CDCaesarean delivery

DMDsDisease-modifying drugs

RRRelapsing-remitting

ORsOdds ratios

CIsConfidence intervals

SDStandard Deviations

EDSSExpanded Disability Status Scale.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2377-12-165 contains supplementary material, which is available to authorized users.

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Author: Luisa Pastò - Emilio Portaccio - Angelo Ghezzi - Bahia Hakiki - Marta Giannini - Lorenzo Razzolini - Elisa Piscolla - Laur

Source: https://link.springer.com/







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