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Research paper
Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs
  1. Emilio Portaccio1,
  2. Angelo Ghezzi2,
  3. Bahia Hakiki1,
  4. Andrea Sturchio1,
  5. Vittorio Martinelli3,
  6. Lucia Moiola3,
  7. Francesco Patti4,
  8. Gian Luigi Mancardi5,
  9. Claudio Solaro6,
  10. Maria Rosaria Tola7,
  11. Carlo Pozzilli8,
  12. Laura De Giglio8,
  13. Rocco Totaro9,
  14. Alessandra Lugaresi10,
  15. Giovanna De Luca10,
  16. Damiano Paolicelli11,
  17. Maria Giovanna Marrosu12,
  18. Giancarlo Comi3,
  19. Maria Trojano11,
  20. Maria Pia Amato1,
  21. for the MS Study Group of the Italian Neurological Society
  1. 1Department of NEUROFARBA, University of Florence, Florence, Italy
  2. 2Hospital of Gallarate, Gallarate (VA), Italy
  3. 3Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
  4. 4Department of Neurology, University of Catania, Catania, Italy
  5. 5Department of Neurology, University of Genova, Genova, Italy
  6. 6Department of Neurology, ASL3 Genovese, Genova, Italy
  7. 7Department of Neurology, University of Ferrara, Ferrara, Italy
  8. 8Department of Neurology and Psychiatry, “La Sapienza” University, Rome, Italy
  9. 9Department of Neurology, University of L'Aquila, L'Aquila, Italy
  10. 10Department of Neuroscience and Imaging, University “G. d'Annunzio” of Chieti, Chieti, Italy
  11. 11Department of Neurology, University of Bari, Bari, Italy
  12. 12Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
  1. Correspondence to Dr Emilio Portaccio, Department of NEUROFARBA, University of Florence, Viale Morgagni 85, Florence 50134, Italy; portilio{at}


Objective To assess relapses, disability progression and the role of disease modifying drugs (DMDs) in the year after delivery in women with multiple sclerosis (MS).

Methods We prospectively followed-up pregnancies occurring between 2002 and 2008 in women with MS, recruited from 21 Italian MS centres. The risk of relapses and disability progression in the year after delivery was assessed using time-dependent Cox regression analysis.

Results 350 out of 423 pregnancies were assessed (pregnancies not resulting in live birth and with a postpartum follow-up period shorter than 1 year were excluded from the analysis). 148 patients (42.3%) had at least one relapse in the year after delivery. An Expanded Disability Status Scale (EDSS) score at conception ≥2.0 (HR=1.4; 95% CI 1.1 to 2.0; p=0.046) and a higher number of relapses before (HR=1.5; 95% CI 1.2 to 1.8; p<0.001) and during pregnancy (HR=2.3; 95% CI 1.6 to 3.4; p<0.001) were related to a higher risk of postpartum relapses. On the contrary, early DMD resumption after delivery marginally reduced the risk of postpartum relapses (HR=0.7, 95% CI 0.4 to 1.0; p=0.079). Moreover, 44/338 women progressed by at least one point on the EDSS. Disability progression was associated with a higher number of relapses before (HR=1.4, 95% CI 1.1 to 1.9; p=0.047) and after delivery (HR=2.7, 95% CI 1.4 to 5.2; p=0.002).

Conclusions Our findings show an increased risk of postpartum relapses and disability accrual in women with higher disease activity before and during pregnancy. Since it may reduce the risk of postpartum relapses, early DMD resumption should be encouraged, particularly in patients with more active disease.

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