Predictors and dynamics of postpartum relapses in women with multiple sclerosis
Background: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies. Objective: To re-examine effect of pregnancy on relapses using...
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| Veröffentlicht in: | Multiple sclerosis 2014-05, Vol.20 (6), p.739-746 |
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| creator | Hughes, Stella E Spelman, Tim Gray, Orla M Boz, Cavit Trojano, Maria Lugaresi, Alessandra Izquierdo, Guillermo Duquette, Pierre Girard, Marc Grand’Maison, Francois Grammond, Pierre Oreja-Guevara, Celia Hupperts, Raymond Bergamaschi, Roberto Giuliani, Giorgio Lechner-Scott, Jeannette Barnett, Michael Edite Rio, Maria van Pesch, Vincent Amato, Maria Pia Iuliano, Gerardo Slee, Mark Verheul, Freek Cristiano, Edgardo Fernández-Bolaños, Ricardo Poehlau, Dieter Saladino, Maria Laura Deri, Norma Cabrera-Gomez, Jose Vella, Norbert Herbert, Joseph Skromne, Eli Savino, Aldo Shaw, Cameron Moore, Fraser Vucic, Steve Petkovska-Boskova, Tatjana McDonnell, Gavin Hawkins, Stanley Kee, Frank Butzkueven, Helmut Paolicelli, Damiano Lucchese, Guglielmo Iaffaldano, Pietro Zwanikken, Cees De Luca, Giovanna Di Tommaso, Valeria Travaglini, Daniela Pietrolongo, Erika di Ioia, Maria Farina, Deborah Mancinelli, Luca Marriott, Mark Kilpatrick, Trevor King, John van der Walt, Anneke Skibina, Olga Haartsen, Jodi Chamorro, Beatriz Petersen, Thor Cartechini, Elisabetta Pucci, Eugenio William, David Dark, Lisa Fiol, Marcela Correale, Jorge Ysrraelit, Celica Den Braber-Moerland, Leontien Jaacks, Gonzalo Laffue, Alfredo Fernanda Páez, María Muñoz, Daniel Oleschko Arruda, Walter Paine, Mark Vella, Malcolm Vetere, Santiago |
| description | Background:
Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.
Objective:
To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.
Methods:
An observational case–control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.
Results:
The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.
Conclusion:
Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy. |
| doi_str_mv | 10.1177/1352458513507816 |
| format | Article |
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Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.
Objective:
To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.
Methods:
An observational case–control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.
Results:
The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.
Conclusion:
Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.</description><identifier>ISSN: 1352-4585</identifier><identifier>EISSN: 1477-0970</identifier><identifier>DOI: 10.1177/1352458513507816</identifier><identifier>PMID: 24107309</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Case-Control Studies ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Disability Evaluation ; Female ; Humans ; Immunomodulators ; Medical sciences ; Middle Aged ; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis ; Multiple Sclerosis, Relapsing-Remitting - diagnosis ; Multiple Sclerosis, Relapsing-Remitting - physiopathology ; Neurology ; Pharmacology. Drug treatments ; Postpartum Period ; Pregnancy ; Risk</subject><ispartof>Multiple sclerosis, 2014-05, Vol.20 (6), p.739-746</ispartof><rights>The Author(s) 2013</rights><rights>2015 INIST-CNRS</rights><rights>SAGE Publications © May 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-bf45caf4d6ca0bdfdca81c05c461419c88720c392e24f9ce262d63180869d13b3</citedby><cites>FETCH-LOGICAL-c428t-bf45caf4d6ca0bdfdca81c05c461419c88720c392e24f9ce262d63180869d13b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1352458513507816$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1352458513507816$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28596632$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24107309$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hughes, Stella E</creatorcontrib><creatorcontrib>Spelman, Tim</creatorcontrib><creatorcontrib>Gray, Orla M</creatorcontrib><creatorcontrib>Boz, Cavit</creatorcontrib><creatorcontrib>Trojano, Maria</creatorcontrib><creatorcontrib>Lugaresi, Alessandra</creatorcontrib><creatorcontrib>Izquierdo, Guillermo</creatorcontrib><creatorcontrib>Duquette, Pierre</creatorcontrib><creatorcontrib>Girard, Marc</creatorcontrib><creatorcontrib>Grand’Maison, Francois</creatorcontrib><creatorcontrib>Grammond, Pierre</creatorcontrib><creatorcontrib>Oreja-Guevara, Celia</creatorcontrib><creatorcontrib>Hupperts, Raymond</creatorcontrib><creatorcontrib>Bergamaschi, Roberto</creatorcontrib><creatorcontrib>Giuliani, Giorgio</creatorcontrib><creatorcontrib>Lechner-Scott, Jeannette</creatorcontrib><creatorcontrib>Barnett, Michael</creatorcontrib><creatorcontrib>Edite Rio, Maria</creatorcontrib><creatorcontrib>van Pesch, Vincent</creatorcontrib><creatorcontrib>Amato, Maria Pia</creatorcontrib><creatorcontrib>Iuliano, Gerardo</creatorcontrib><creatorcontrib>Slee, Mark</creatorcontrib><creatorcontrib>Verheul, Freek</creatorcontrib><creatorcontrib>Cristiano, Edgardo</creatorcontrib><creatorcontrib>Fernández-Bolaños, Ricardo</creatorcontrib><creatorcontrib>Poehlau, Dieter</creatorcontrib><creatorcontrib>Saladino, Maria Laura</creatorcontrib><creatorcontrib>Deri, Norma</creatorcontrib><creatorcontrib>Cabrera-Gomez, Jose</creatorcontrib><creatorcontrib>Vella, Norbert</creatorcontrib><creatorcontrib>Herbert, Joseph</creatorcontrib><creatorcontrib>Skromne, Eli</creatorcontrib><creatorcontrib>Savino, Aldo</creatorcontrib><creatorcontrib>Shaw, Cameron</creatorcontrib><creatorcontrib>Moore, Fraser</creatorcontrib><creatorcontrib>Vucic, Steve</creatorcontrib><creatorcontrib>Petkovska-Boskova, Tatjana</creatorcontrib><creatorcontrib>McDonnell, Gavin</creatorcontrib><creatorcontrib>Hawkins, Stanley</creatorcontrib><creatorcontrib>Kee, Frank</creatorcontrib><creatorcontrib>Butzkueven, Helmut</creatorcontrib><creatorcontrib>Paolicelli, Damiano</creatorcontrib><creatorcontrib>Lucchese, Guglielmo</creatorcontrib><creatorcontrib>Iaffaldano, Pietro</creatorcontrib><creatorcontrib>Zwanikken, Cees</creatorcontrib><creatorcontrib>De Luca, Giovanna</creatorcontrib><creatorcontrib>Di Tommaso, Valeria</creatorcontrib><creatorcontrib>Travaglini, Daniela</creatorcontrib><creatorcontrib>Pietrolongo, Erika</creatorcontrib><creatorcontrib>di Ioia, Maria</creatorcontrib><creatorcontrib>Farina, Deborah</creatorcontrib><creatorcontrib>Mancinelli, Luca</creatorcontrib><creatorcontrib>Marriott, Mark</creatorcontrib><creatorcontrib>Kilpatrick, Trevor</creatorcontrib><creatorcontrib>King, John</creatorcontrib><creatorcontrib>van der Walt, Anneke</creatorcontrib><creatorcontrib>Skibina, Olga</creatorcontrib><creatorcontrib>Haartsen, Jodi</creatorcontrib><creatorcontrib>Chamorro, Beatriz</creatorcontrib><creatorcontrib>Petersen, Thor</creatorcontrib><creatorcontrib>Cartechini, Elisabetta</creatorcontrib><creatorcontrib>Pucci, Eugenio</creatorcontrib><creatorcontrib>William, David</creatorcontrib><creatorcontrib>Dark, Lisa</creatorcontrib><creatorcontrib>Fiol, Marcela</creatorcontrib><creatorcontrib>Correale, Jorge</creatorcontrib><creatorcontrib>Ysrraelit, Celica</creatorcontrib><creatorcontrib>Den Braber-Moerland, Leontien</creatorcontrib><creatorcontrib>Jaacks, Gonzalo</creatorcontrib><creatorcontrib>Laffue, Alfredo</creatorcontrib><creatorcontrib>Fernanda Páez, María</creatorcontrib><creatorcontrib>Muñoz, Daniel</creatorcontrib><creatorcontrib>Oleschko Arruda, Walter</creatorcontrib><creatorcontrib>Paine, Mark</creatorcontrib><creatorcontrib>Vella, Malcolm</creatorcontrib><creatorcontrib>Vetere, Santiago</creatorcontrib><creatorcontrib>MSBase study group</creatorcontrib><creatorcontrib>for the MSBase study group</creatorcontrib><title>Predictors and dynamics of postpartum relapses in women with multiple sclerosis</title><title>Multiple sclerosis</title><addtitle>Mult Scler</addtitle><description>Background:
Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.
Objective:
To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.
Methods:
An observational case–control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.
Results:
The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.
Conclusion:
Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</subject><subject>Disability Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Immunomodulators</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</subject><subject>Multiple Sclerosis, Relapsing-Remitting - diagnosis</subject><subject>Multiple Sclerosis, Relapsing-Remitting - physiopathology</subject><subject>Neurology</subject><subject>Pharmacology. Drug treatments</subject><subject>Postpartum Period</subject><subject>Pregnancy</subject><subject>Risk</subject><issn>1352-4585</issn><issn>1477-0970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkctrVTEQxoMotlb3riQggpvTziQ5eSyl-IJCXdT1ITfJ0ZTzMnMO0v_eXO71QUG6mRmY38zky8fYS4RzRGMuULZCtbatGYxF_YidojKmAWfgca1ru9n3T9gzolsAMEa2T9mJUAhGgjtl119KijmscyHup8jj3eTHHIjPPV9mWhdf1m3kJQ1-oUQ8T_znPKYa8_qdj9uw5mVInMKQykyZnrMnvR8ovTjmM_b1w_uby0_N1fXHz5fvrpqghF2bXa_a4HsVdfCwi30M3mKANiiNCl2w1ggI0okkVO9CElpELdGC1S6i3Mkz9vawdynzjy3R2o2ZQhoGP6V5ow61BgUKtXgYbdHWv3MGK_r6Hno7b2WqQvaUqwhKWyk4UKFKppL6bil59OWuQ-j2vnT3fakjr46Lt92Y4p-B30ZU4M0R8BT80Bc_hUx_Ods6reVeTHPgyH9L_7zuf4d_AXc8oMQ</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>Hughes, Stella E</creator><creator>Spelman, Tim</creator><creator>Gray, Orla M</creator><creator>Boz, Cavit</creator><creator>Trojano, Maria</creator><creator>Lugaresi, Alessandra</creator><creator>Izquierdo, Guillermo</creator><creator>Duquette, Pierre</creator><creator>Girard, Marc</creator><creator>Grand’Maison, Francois</creator><creator>Grammond, Pierre</creator><creator>Oreja-Guevara, Celia</creator><creator>Hupperts, Raymond</creator><creator>Bergamaschi, Roberto</creator><creator>Giuliani, Giorgio</creator><creator>Lechner-Scott, Jeannette</creator><creator>Barnett, Michael</creator><creator>Edite Rio, Maria</creator><creator>van Pesch, Vincent</creator><creator>Amato, Maria Pia</creator><creator>Iuliano, Gerardo</creator><creator>Slee, Mark</creator><creator>Verheul, Freek</creator><creator>Cristiano, Edgardo</creator><creator>Fernández-Bolaños, Ricardo</creator><creator>Poehlau, Dieter</creator><creator>Saladino, Maria Laura</creator><creator>Deri, Norma</creator><creator>Cabrera-Gomez, Jose</creator><creator>Vella, Norbert</creator><creator>Herbert, Joseph</creator><creator>Skromne, Eli</creator><creator>Savino, Aldo</creator><creator>Shaw, Cameron</creator><creator>Moore, Fraser</creator><creator>Vucic, Steve</creator><creator>Petkovska-Boskova, Tatjana</creator><creator>McDonnell, Gavin</creator><creator>Hawkins, Stanley</creator><creator>Kee, Frank</creator><creator>Butzkueven, Helmut</creator><creator>Paolicelli, Damiano</creator><creator>Lucchese, Guglielmo</creator><creator>Iaffaldano, Pietro</creator><creator>Zwanikken, Cees</creator><creator>De Luca, Giovanna</creator><creator>Di Tommaso, Valeria</creator><creator>Travaglini, Daniela</creator><creator>Pietrolongo, Erika</creator><creator>di Ioia, Maria</creator><creator>Farina, Deborah</creator><creator>Mancinelli, Luca</creator><creator>Marriott, Mark</creator><creator>Kilpatrick, Trevor</creator><creator>King, John</creator><creator>van der Walt, Anneke</creator><creator>Skibina, Olga</creator><creator>Haartsen, Jodi</creator><creator>Chamorro, Beatriz</creator><creator>Petersen, Thor</creator><creator>Cartechini, Elisabetta</creator><creator>Pucci, Eugenio</creator><creator>William, David</creator><creator>Dark, Lisa</creator><creator>Fiol, Marcela</creator><creator>Correale, Jorge</creator><creator>Ysrraelit, Celica</creator><creator>Den Braber-Moerland, Leontien</creator><creator>Jaacks, Gonzalo</creator><creator>Laffue, Alfredo</creator><creator>Fernanda Páez, María</creator><creator>Muñoz, Daniel</creator><creator>Oleschko Arruda, Walter</creator><creator>Paine, Mark</creator><creator>Vella, Malcolm</creator><creator>Vetere, Santiago</creator><general>SAGE Publications</general><general>Sage Publications</general><general>Sage Publications Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20140501</creationdate><title>Predictors and dynamics of postpartum relapses in women with multiple sclerosis</title><author>Hughes, Stella E ; Spelman, Tim ; Gray, Orla M ; Boz, Cavit ; Trojano, Maria ; Lugaresi, Alessandra ; Izquierdo, Guillermo ; Duquette, Pierre ; Girard, Marc ; Grand’Maison, Francois ; Grammond, Pierre ; Oreja-Guevara, Celia ; Hupperts, Raymond ; Bergamaschi, Roberto ; Giuliani, Giorgio ; Lechner-Scott, Jeannette ; Barnett, Michael ; Edite Rio, Maria ; van Pesch, Vincent ; Amato, Maria Pia ; Iuliano, Gerardo ; Slee, Mark ; Verheul, Freek ; Cristiano, Edgardo ; Fernández-Bolaños, Ricardo ; Poehlau, Dieter ; Saladino, Maria Laura ; Deri, Norma ; Cabrera-Gomez, Jose ; Vella, Norbert ; Herbert, Joseph ; Skromne, Eli ; Savino, Aldo ; Shaw, Cameron ; Moore, Fraser ; Vucic, Steve ; Petkovska-Boskova, Tatjana ; McDonnell, Gavin ; Hawkins, Stanley ; Kee, Frank ; Butzkueven, Helmut ; Paolicelli, Damiano ; Lucchese, Guglielmo ; Iaffaldano, Pietro ; Zwanikken, Cees ; De Luca, Giovanna ; Di Tommaso, Valeria ; Travaglini, Daniela ; Pietrolongo, Erika ; di Ioia, Maria ; Farina, Deborah ; Mancinelli, Luca ; Marriott, Mark ; Kilpatrick, Trevor ; King, John ; van der Walt, Anneke ; Skibina, Olga ; Haartsen, Jodi ; Chamorro, Beatriz ; Petersen, Thor ; Cartechini, Elisabetta ; Pucci, Eugenio ; William, David ; Dark, Lisa ; Fiol, Marcela ; Correale, Jorge ; Ysrraelit, Celica ; Den Braber-Moerland, Leontien ; Jaacks, Gonzalo ; Laffue, Alfredo ; Fernanda Páez, María ; Muñoz, Daniel ; Oleschko Arruda, Walter ; Paine, Mark ; Vella, Malcolm ; Vetere, Santiago</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-bf45caf4d6ca0bdfdca81c05c461419c88720c392e24f9ce262d63180869d13b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</topic><topic>Disability Evaluation</topic><topic>Female</topic><topic>Humans</topic><topic>Immunomodulators</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</topic><topic>Multiple Sclerosis, Relapsing-Remitting - diagnosis</topic><topic>Multiple Sclerosis, Relapsing-Remitting - physiopathology</topic><topic>Neurology</topic><topic>Pharmacology. Drug treatments</topic><topic>Postpartum Period</topic><topic>Pregnancy</topic><topic>Risk</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hughes, Stella E</creatorcontrib><creatorcontrib>Spelman, Tim</creatorcontrib><creatorcontrib>Gray, Orla M</creatorcontrib><creatorcontrib>Boz, Cavit</creatorcontrib><creatorcontrib>Trojano, Maria</creatorcontrib><creatorcontrib>Lugaresi, Alessandra</creatorcontrib><creatorcontrib>Izquierdo, Guillermo</creatorcontrib><creatorcontrib>Duquette, Pierre</creatorcontrib><creatorcontrib>Girard, Marc</creatorcontrib><creatorcontrib>Grand’Maison, Francois</creatorcontrib><creatorcontrib>Grammond, Pierre</creatorcontrib><creatorcontrib>Oreja-Guevara, Celia</creatorcontrib><creatorcontrib>Hupperts, Raymond</creatorcontrib><creatorcontrib>Bergamaschi, Roberto</creatorcontrib><creatorcontrib>Giuliani, Giorgio</creatorcontrib><creatorcontrib>Lechner-Scott, Jeannette</creatorcontrib><creatorcontrib>Barnett, Michael</creatorcontrib><creatorcontrib>Edite Rio, Maria</creatorcontrib><creatorcontrib>van Pesch, Vincent</creatorcontrib><creatorcontrib>Amato, Maria Pia</creatorcontrib><creatorcontrib>Iuliano, Gerardo</creatorcontrib><creatorcontrib>Slee, Mark</creatorcontrib><creatorcontrib>Verheul, Freek</creatorcontrib><creatorcontrib>Cristiano, Edgardo</creatorcontrib><creatorcontrib>Fernández-Bolaños, Ricardo</creatorcontrib><creatorcontrib>Poehlau, Dieter</creatorcontrib><creatorcontrib>Saladino, Maria Laura</creatorcontrib><creatorcontrib>Deri, Norma</creatorcontrib><creatorcontrib>Cabrera-Gomez, Jose</creatorcontrib><creatorcontrib>Vella, Norbert</creatorcontrib><creatorcontrib>Herbert, Joseph</creatorcontrib><creatorcontrib>Skromne, Eli</creatorcontrib><creatorcontrib>Savino, Aldo</creatorcontrib><creatorcontrib>Shaw, Cameron</creatorcontrib><creatorcontrib>Moore, Fraser</creatorcontrib><creatorcontrib>Vucic, Steve</creatorcontrib><creatorcontrib>Petkovska-Boskova, Tatjana</creatorcontrib><creatorcontrib>McDonnell, Gavin</creatorcontrib><creatorcontrib>Hawkins, Stanley</creatorcontrib><creatorcontrib>Kee, Frank</creatorcontrib><creatorcontrib>Butzkueven, Helmut</creatorcontrib><creatorcontrib>Paolicelli, Damiano</creatorcontrib><creatorcontrib>Lucchese, Guglielmo</creatorcontrib><creatorcontrib>Iaffaldano, Pietro</creatorcontrib><creatorcontrib>Zwanikken, Cees</creatorcontrib><creatorcontrib>De Luca, Giovanna</creatorcontrib><creatorcontrib>Di Tommaso, Valeria</creatorcontrib><creatorcontrib>Travaglini, Daniela</creatorcontrib><creatorcontrib>Pietrolongo, Erika</creatorcontrib><creatorcontrib>di Ioia, Maria</creatorcontrib><creatorcontrib>Farina, Deborah</creatorcontrib><creatorcontrib>Mancinelli, Luca</creatorcontrib><creatorcontrib>Marriott, Mark</creatorcontrib><creatorcontrib>Kilpatrick, Trevor</creatorcontrib><creatorcontrib>King, John</creatorcontrib><creatorcontrib>van der Walt, Anneke</creatorcontrib><creatorcontrib>Skibina, Olga</creatorcontrib><creatorcontrib>Haartsen, Jodi</creatorcontrib><creatorcontrib>Chamorro, Beatriz</creatorcontrib><creatorcontrib>Petersen, Thor</creatorcontrib><creatorcontrib>Cartechini, Elisabetta</creatorcontrib><creatorcontrib>Pucci, Eugenio</creatorcontrib><creatorcontrib>William, David</creatorcontrib><creatorcontrib>Dark, Lisa</creatorcontrib><creatorcontrib>Fiol, Marcela</creatorcontrib><creatorcontrib>Correale, Jorge</creatorcontrib><creatorcontrib>Ysrraelit, Celica</creatorcontrib><creatorcontrib>Den Braber-Moerland, Leontien</creatorcontrib><creatorcontrib>Jaacks, Gonzalo</creatorcontrib><creatorcontrib>Laffue, Alfredo</creatorcontrib><creatorcontrib>Fernanda Páez, María</creatorcontrib><creatorcontrib>Muñoz, Daniel</creatorcontrib><creatorcontrib>Oleschko Arruda, Walter</creatorcontrib><creatorcontrib>Paine, Mark</creatorcontrib><creatorcontrib>Vella, Malcolm</creatorcontrib><creatorcontrib>Vetere, Santiago</creatorcontrib><creatorcontrib>MSBase study group</creatorcontrib><creatorcontrib>for the MSBase study group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Multiple sclerosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hughes, Stella E</au><au>Spelman, Tim</au><au>Gray, Orla M</au><au>Boz, Cavit</au><au>Trojano, Maria</au><au>Lugaresi, Alessandra</au><au>Izquierdo, Guillermo</au><au>Duquette, Pierre</au><au>Girard, Marc</au><au>Grand’Maison, Francois</au><au>Grammond, Pierre</au><au>Oreja-Guevara, Celia</au><au>Hupperts, Raymond</au><au>Bergamaschi, Roberto</au><au>Giuliani, Giorgio</au><au>Lechner-Scott, Jeannette</au><au>Barnett, Michael</au><au>Edite Rio, Maria</au><au>van Pesch, Vincent</au><au>Amato, Maria Pia</au><au>Iuliano, Gerardo</au><au>Slee, Mark</au><au>Verheul, Freek</au><au>Cristiano, Edgardo</au><au>Fernández-Bolaños, Ricardo</au><au>Poehlau, Dieter</au><au>Saladino, Maria Laura</au><au>Deri, Norma</au><au>Cabrera-Gomez, Jose</au><au>Vella, Norbert</au><au>Herbert, Joseph</au><au>Skromne, Eli</au><au>Savino, Aldo</au><au>Shaw, Cameron</au><au>Moore, Fraser</au><au>Vucic, Steve</au><au>Petkovska-Boskova, Tatjana</au><au>McDonnell, Gavin</au><au>Hawkins, Stanley</au><au>Kee, Frank</au><au>Butzkueven, Helmut</au><au>Paolicelli, Damiano</au><au>Lucchese, Guglielmo</au><au>Iaffaldano, Pietro</au><au>Zwanikken, Cees</au><au>De Luca, Giovanna</au><au>Di Tommaso, Valeria</au><au>Travaglini, Daniela</au><au>Pietrolongo, Erika</au><au>di Ioia, Maria</au><au>Farina, Deborah</au><au>Mancinelli, Luca</au><au>Marriott, Mark</au><au>Kilpatrick, Trevor</au><au>King, John</au><au>van der Walt, Anneke</au><au>Skibina, Olga</au><au>Haartsen, Jodi</au><au>Chamorro, Beatriz</au><au>Petersen, Thor</au><au>Cartechini, Elisabetta</au><au>Pucci, Eugenio</au><au>William, David</au><au>Dark, Lisa</au><au>Fiol, Marcela</au><au>Correale, Jorge</au><au>Ysrraelit, Celica</au><au>Den Braber-Moerland, Leontien</au><au>Jaacks, Gonzalo</au><au>Laffue, Alfredo</au><au>Fernanda Páez, María</au><au>Muñoz, Daniel</au><au>Oleschko Arruda, Walter</au><au>Paine, Mark</au><au>Vella, Malcolm</au><au>Vetere, Santiago</au><aucorp>MSBase study group</aucorp><aucorp>for the MSBase study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors and dynamics of postpartum relapses in women with multiple sclerosis</atitle><jtitle>Multiple sclerosis</jtitle><addtitle>Mult Scler</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>20</volume><issue>6</issue><spage>739</spage><epage>746</epage><pages>739-746</pages><issn>1352-4585</issn><eissn>1477-0970</eissn><abstract>Background:
Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies.
Objective:
To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse.
Methods:
An observational case–control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses.
Results:
The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model.
Conclusion:
Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>24107309</pmid><doi>10.1177/1352458513507816</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1352-4585 |
| ispartof | Multiple sclerosis, 2014-05, Vol.20 (6), p.739-746 |
| issn | 1352-4585 1477-0970 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1660404162 |
| source | MEDLINE; SAGE Journals |
| subjects | Adult Aged Biological and medical sciences Case-Control Studies Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Disability Evaluation Female Humans Immunomodulators Medical sciences Middle Aged Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Multiple Sclerosis, Relapsing-Remitting - diagnosis Multiple Sclerosis, Relapsing-Remitting - physiopathology Neurology Pharmacology. Drug treatments Postpartum Period Pregnancy Risk |
| title | Predictors and dynamics of postpartum relapses in women with multiple sclerosis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T17%3A24%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Predictors%20and%20dynamics%20of%20postpartum%20relapses%20in%20women%20with%20multiple%20sclerosis&rft.jtitle=Multiple%20sclerosis&rft.au=Hughes,%20Stella%20E&rft.aucorp=MSBase%20study%20group&rft.date=2014-05-01&rft.volume=20&rft.issue=6&rft.spage=739&rft.epage=746&rft.pages=739-746&rft.issn=1352-4585&rft.eissn=1477-0970&rft_id=info:doi/10.1177/1352458513507816&rft_dat=%3Cproquest_cross%3E3289407031%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1519971138&rft_id=info:pmid/24107309&rft_sage_id=10.1177_1352458513507816&rfr_iscdi=true |