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Pregnancy and multiple sclerosis in the DMT era: insights from a cohort study in Western Austria
Author(s): ,
G. Bsteh
Affiliations:
Neurology, Medical University of Innsbruck, Innsbruck, Austria
,
L. Algrang
Affiliations:
Neurology, Medical University of Innsbruck, Innsbruck, Austria
,
H. Hegen
Affiliations:
Neurology, Medical University of Innsbruck, Innsbruck, Austria
,
M. Auer
Affiliations:
Neurology, Medical University of Innsbruck, Innsbruck, Austria
,
S. Wurth
Affiliations:
Neurology, Medical University of Innsbruck, Innsbruck, Austria
,
F. Di Pauli
Affiliations:
Neurology, Medical University of Innsbruck, Innsbruck, Austria
,
F. Deisenhammer
Affiliations:
Neurology, Medical University of Innsbruck, Innsbruck, Austria
T. Berger
Affiliations:
Neurology, Medical University of Innsbruck, Innsbruck, Austria
ECTRIMS Online Library. Bsteh G. Oct 12, 2018; 228152
Gabriel Bsteh
Gabriel Bsteh
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Abstract: P1774

Type: Poster Sessions

Abstract Category: N/A

Background: Multiple sclerosis (MS) predominantly affects women of child-bearing potential. Pregnancy in MS is still a controversial issue lacking standardized treatment recommendations.
Objective: The objective of this study was to examine the reciprocal effects of pregnancy, multiple sclerosis, disease-modifying treatment (DMT) and breastfeeding as well as obstetrical outcomes in a real-world cohort of women with MS treated in the era of highly effective DMT (H-DMT).
Methods: We analyzed 387 pregnancies in 239 women with RRMS and ³1 pregnancy, establishment of diagnosis >1 year after conception and ³2 years of follow up after birth. Relapse rates and Expanded Disability Status Scale (EDSS) scores were compared in the year before conception, during pregnancy and two years postpartum. Binary logistic regression was used to investigate predictors of risk for relapses and disability progression during pregnancy and postpartum. Birth outcome was compared to the general population in Western Austria extracted from the Austrian birth registry.
Results: Risk of relapse and disability progression during pregnancy was predicted by pre-conception relapse activity, higher EDSS score at conception, use of H-DMT pre-conception and prolonged washout period. Postpartum relapse and disability progression was associated relapse activity pre-conception and during pregnancy and use of H-DMT pre-conception. Early restart of DMT reduced the risk of postpartum relapse. Caesarean delivery, epidural anesthesia or breastfeeding did not have an impact on relapse risk or disability progression in pregnancy or postpartum. Neither spontaneous abortions nor fetal deaths were more frequent in women treated with DMT pre-pregnancy. Compared to the control cohort, newborns from women with MS had significantly lower birth weight.
Conclusion: In women with MS planning pregnancy while on H-DMT, it seems reasonable maintaining H-DMT closer to conception and restarting the drug early postpartum to reduce the considerable risk of disease reactivation during pregnancy and after delivery.
Disclosure: Gabriel Bsteh: hasparticipated in meetings sponsored by, received speaker honoraria or travel funding fromBiogen, Merck,Novartis, Sanofi-Genzymeand Teva, and received honoraria for consulting Teva.
Laura Algrang: declares no conflicts of interest.
Harald Hegen: has participated in meetings sponsored by, received speaker honoraria or travel funding from Bayer, Biogen, Merck, Novartis and Sanofi-Genzyme, and received honoraria for consulting Teva.
Michael Auer: received speaker honoraria and/or travel grants from Merck, Novartis and Biogen.
Sebastian Wurth: has participated in meetings sponsored by, received honoraria or travel funding from Biogen, Merck,Novartis, Sanofi Genzyme, Teva, Allergan, Ipsen Pharma and Roche.
Franziska Di Pauli: has received speaking honoraria from Biogen and Sanofi-Genzyme.
Florian Deisenhammer: has participated in meetings sponsored by or received honoraria for acting as an advisor/speaker for Bayer, Biogen, Sanofi-Genzyme, Merck, Novartis, and Roche.
Thomas Berger: has participated in meetings sponsored by and received honoraria (lectures, advisory boards, consultations) from pharmaceutical companies marketing treatments for MS: Allergan, Bayer, Biogen, Bionorica, Celgene, MedDay, Merck, Novartis, Octapharma, Roche, Sanofi-Genzyme, Teva. His institution has received financial support in the past 12 months by unrestricted research grants (Biogen, Bayer, Merck, Novartis, Sanofi Aventis, Teva and for participation in clinical trials in multiple sclerosis sponsored by Alexion, Bayer, Biogen, Merck, Novartis, Octapharma, Roche, Sanofi-

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