MS Diagnosis Alone May Not Deem Pregnancy "High Risk," Study Finds

During an oral presentation of abstracts at the American Academy of Neurology’s 2019 Annual Meeting in Philadelphia, Pennsylvania, held May 4-10, researchers presented findings that suggest that while pregnant women with multiple sclerosis (MS) are often viewed as high-risk by their physician, pregnancy did not seem to increase the risk of adverse obstetrical outcomes for patients nor their babies.

The study noted that nearly 33% of women with MS become pregnant after disease onset. Some disease-modifying therapies (DMTs) often prescribed to treat MS have the potential to cause complications during pregnancy, and for this reason physicians usually recommend that patients with MS who plan to become pregnant should discontinue such therapies prior to conception.

“However, there is no published data to suggest that pregnancies in MS patients should be considered an obstetrical high risk due to neurologic condition alone,” wrote the authors.

They examined physicians’ perception of pregnancy risk and disease course in women with MS by analyzing early results from the PREG-MS study, which seeks to follow female patients with MS in the United States who are actively trying to conceive. The participants are followed from conception to 3 years postbirth. Information is collected regarding the patients’ disease course and pregnancy via phone interviews and verified through medical records.

Of the 116 patients tracked thus far in the study, 70 are currently pregnant or have delivered. These patients' baseline Expanded Disability Status Scale (EDSS) was 0.92 ± 0.13, indicating a low disability level. Among these 70 patients, 16 had early pregnancy DMT exposures (4.31 ± 0.66 weeks) and 2 participants remained on glatiramer acetate throughout their respective pregnancies.

Notably, 49 pregnancies were deemed high risk by obstetricians. Of these, 7 pregnancies were exposed to DMT, 17 were considered high risk due to MS diagnosis alone, and 25 were considered high risk due to non-MS—related factors.

“High-risk pregnancy designation for MS diagnosis alone did not predict obstetric complication in pregnancy or delivery, nor an adverse neonatal outcome. Additionally, these patients were not at a greater risk for a relapse during pregnancy or in the postpartum period with up to 9 months follow up,” wrote the authors.

According to the researchers, although there is data to suggest that DMT exposure can be problematic during pregnancy, the authors concluded that an “MS diagnosis itself does not appear to imply adverse pregnancy outcomes in our prospective cohort.”

Reference

Manieri M, Mahlanza T, Houtchens M. Pregnancies in women with multiple sclerosis: perception of high risk among health care providers. Interim data from PREG-MS cohort. Presented at: American Academy of Neurology 2019 Annual Meeting; May 4-11; Philadelphia, Pennsylvania. Abstract S27.006.