Brain Advance Access originally published online on May 6, 2004
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Brain, Vol. 127, No. 6, 1353-1360, 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh152
Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse
1 European Database for Multiple Sclerosis (EDMUS) Coordinating Center and Service de Neurologie A, Hôpital Neurologique Pierre Wertheimer and INSERM U433, Lyon, 2 Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, 3 Service de Médecine Interne, Centre Hospitalier Général, Avignon, 4 Département d’Informatique Médicale et de Biostatistiques, Hospices Civils de Lyon, Lyon, France and 5 Department of Neurology, St Vincent’s University Hospital, Dublin, Ireland
*Participants in the PRIMS study are listed in the Appendix. Correspondence to: Professor Christian Confavreux at the EDMUS Coordinating Center, Service de Neurologie A, Hôpital Neurologique Pierre Wertheimer, 59 boulevard Pinel, 69394 Lyon cedex 03, France. E-mail: christian.confavreux{at}chu-lyon.fr
The influence of pregnancy in multiple sclerosis has been a matter of controversy for a long time. The Pregnancy in Multiple Sclerosis (PRIMS) study was the first large prospective study which aimed to assess the possible influence of pregnancy and delivery on the clinical course of multiple sclerosis. We report here the 2-year post-partum follow-up and an analysis of clinical factors which might predict the likelihood of a relapse in the 3 months after delivery. The relapse rate in each trimester up to the end of the second year post-partum was compared with that in the pre-pregnancy year. Clinical predictors of the presence or absence of a post-partum relapse were analysed by logistic regression analysis. Using the best multivariate model, women were classified as having or not having a post-partum relapse predicted, and this was compared with the observed outcome. The results showed that, compared with the pre-pregnancy year, there was a reduction in the relapse rate during pregnancy, most marked in the third trimester, and a marked increase in the first 3 months after delivery. Thereafter, from the second trimester onwards and for the following 21 months, the annualized relapse rate fell slightly but did not differ significantly from the relapse rate recorded in the pre-pregnancy year. Despite the increased risk for the 3 months post-partum, 72% of the women did not experience any relapse during this period. Confirmed disability continued to progress steadily during the study period. Three indices, an increased relapse rate in the pre-pregnancy year, an increased relapse rate during pregnancy and a higher DSS (Kurtzke’s Disability Status Scale) score at pregnancy onset, significantly correlated with the occurrence of a post-partum relapse. Neither epidural analgesia nor breast-feeding was predictive. When comparing the predicted and observed status, however, only 72% of the women were correctly classified by the multivariate model. In conclusion, the results for the second year post-partum confirm that the relapse rate remains similar to that of the pre-pregnancy year, after an increase in the first trimester following delivery. Women with greater disease activity in the year before pregnancy and during pregnancy have a higher risk of relapse in the post- partum 3 months. This is, however, not sufficient to identify in advance women with multiple sclerosis who are more likely to relapse, especially for planning therapeutic trials aiming to prevent post-partum relapses.
Key Words: multiple sclerosis; pregnancy; post-partum; relapse; prognosis
Abbreviations: DSS = Kurtzke’s Disability Status Scale; PRIMS = Pregnancy in Multiple Sclerosis Study
Received November 7, 2003. Revised December 19, 2003. Accepted January 27, 2004.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  I. S. Zagon, K. A. Rahn, A. P. Turel, and P. J. McLaughlin Endogenous Opioids Regulate Expression of Experimental Autoimmune Encephalomyelitis: A New Paradigm for the Treatment of Multiple Sclerosis Experimental Biology and Medicine, November 1, 2009; 234(11): 1383 - 1392. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. F Neuteboom, E. Verbraak, J. S. Voerman, M. van Meurs, E. A. Steegers, C. J. de Groot, J. D Laman, and R. Q Hintzen First trimester interleukin 8 levels are associated with postpartum relapse in multiple sclerosis Multiple Sclerosis, November 1, 2009; 15(11): 1356 - 1358. [Abstract] [PDF]
|
|
|
|
|
|
C Weber-Schoendorfer and C Schaefer Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study Multiple Sclerosis, September 1, 2009; 15(9): 1037 - 1042. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Langer-Gould, S. M. Huang, R. Gupta, A. D. Leimpeter, E. Greenwood, K. B. Albers, S. K. Van Den Eeden, and L. M. Nelson Exclusive Breastfeeding and the Risk of Postpartum Relapses in Women With Multiple Sclerosis Arch Neurol, August 1, 2009; 66(8): 958 - 963. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N Fernandez Liguori, D Klajn, L Acion, F Caceres, A Calle, A Carra, E Cristiano, N Deri, O Garcea, A Jaureguiberry, et al. Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study) Multiple Sclerosis, May 1, 2009; 15(5): 555 - 562. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Hellwig, C. Beste, S. Schimrigk, and A. Chan Immunomodulation and postpartum relapses in patients with multiple sclerosis Therapeutic Advances in Neurological Disorders, January 1, 2009; 2(1): 7 - 11. [Abstract] [PDF]
|
|
|
|
 |
|
 M Lee and P O'Brien Pregnancy and multiple sclerosis J. Neurol. Neurosurg. Psychiatry, December 1, 2008; 79(12): 1308 - 1311. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Argyriou and N. Makris Review Article: Multiple Sclerosis and Reproductive Risks in Women Reproductive Sciences, October 1, 2008; 15(8): 755 - 764. [Abstract] [PDF]
|
|
|
|
|
|
V. De las Heras, C. De Andres, N. Tellez, M. Tintore, and on behalf of the EMPATIE Study Group, Spain Pregnancy in multiple sclerosis patients treated with immunomodulators prior to or during part of the pregnancy: a descriptive study in the Spanish population Multiple Sclerosis, September 1, 2007; 13(8): 981 - 984. [Abstract] [PDF]
|
|
|
|
|
|
W-H Zhu, C-Z Lu, Y-M Huang, H Link, and B-G Xiao A putative mechanism on remission of multiple sclerosis during pregnancy: estrogen-induced indoleamine 2,3-dioxygenase by dendritic cells Multiple Sclerosis, January 1, 2007; 13(1): 33 - 40. [Abstract] [PDF]
|
|
|
|
|
|
C Lopez, M Comabella, M Tintore, J Sastre-Garriga, and X Montalban Variations in chemokine receptor and cytokine expression during pregnancy in multiple sclerosis patients Multiple Sclerosis, August 1, 2006; 12(4): 421 - 427. [Abstract] [PDF]
|
|
|
|
|
|
J S Sloka, W E. Pryse-Phillips, and M Stefanelli The relation between menarche and the age of first symptoms in a multiple sclerosis cohort Multiple Sclerosis, June 1, 2006; 12(3): 333 - 339. [Abstract] [PDF]
|
|
|
|
|
|
S L Minden, D Frankel, L Hadden, J Perloff, K P Srinath, and D C Hoaglin The Sonya Slifka Longitudinal Multiple Sclerosis Study: methods and sample characteristics Multiple Sclerosis, February 1, 2006; 12(1): 24 - 38. [Abstract] [PDF]
|
|
|
|
 |
|
 S. E. Baranzini, C. C. A. Bernard, and J. R. Oksenberg Modular Transcriptional Activity Characterizes the Initiation and Progression of Autoimmune Encephalomyelitis J. Immunol., June 1, 2005; 174(11): 7412 - 7422. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 What Effect Does Pregnancy Have on MS Relapse Rate? Journal Watch Neurology, August 26, 2004; 2004(826): 7 - 7. [Full Text]
|
|