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Research paper
Abortion induces reactivation of inflammation in relapsing-remitting multiple sclerosis
  1. Doriana Landi1,
  2. Paolo Ragonese2,
  3. Luca Prosperini3,
  4. Viviana Nociti4,5,
  5. Shalom Haggiag3,
  6. Antonio Cortese6,
  7. Roberta Fantozzi7,
  8. Simona Pontecorvo6,
  9. Elisabetta Ferraro8,
  10. Maria Chiara Buscarinu9,
  11. Giorgia Mataluni1,
  12. Fabrizia Monteleone1,
  13. Marco Salvetti7,9,
  14. Giancarlo Di Battista8,
  15. Ada Francia6,
  16. Enrico Millefiorini6,
  17. Claudio Gasperini3,
  18. Massimiliano Mirabella4,
  19. Giuseppe Salemi2,
  20. Laura Boffa1,
  21. Carlo Pozzilli9,
  22. Diego Centonze1,7,
  23. Girolama Alessandra Marfia1,7
  1. 1 Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
  2. 2 Department of Biomedicine and Clinical Neuroscience, P. Giaccone University Hospital, Palermo, Italy
  3. 3 Multiple Sclerosis Center, S. Camillo-Forlanini Hospital, Rome, Italy
  4. 4 Multiple Sclerosis Center, Cattolica University, A. Gemelli University Hospital Foundation, Rome, Italy
  5. 5 Neurorehabilitation Department, Don C. Gnocchi Foundation Onlus, Milan, Italy
  6. 6 Multiple Sclerosis Center, Policlinico Umberto I, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
  7. 7 Neurology and Neurorehabilitation Units, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
  8. 8 Multiple Sclerosis Center, San Filippo Neri Hospital - ASL Roma 1, Rome, Italy
  9. 9 Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
  1. Correspondence to Dr Doriana Landi, Multiple Sclerosis Clinical and Research Unit, Tor Vergata Hospital, Rome 00133, Italy; doriana.landi{at}


Objective To investigate clinical and radiological outcomes of women with relapsing-remitting multiple sclerosis (RRMS) undergoing abortion.

Methods An independent, multicentre retrospective study was conducted collecting data from eight Italian MS centres. We compared the preconception and postabortion annualised relapse rate (ARR) and number of Gadolinium enhancing (Gd+) lesions, by analyses of covariance. Variables associated with postabortion clinical and MRI activity were investigated using Poisson regression models; each abortion was considered as a statistical unit.

Results From 1995 to 2017, we observed 188 abortions (17 elective) in 153 women with RRMS. Abortions occurred after a mean time of 9.5 (4.4) weeks from estimated conception date. In 86 events out of 188, conception happened during treatment with disease modifying drugs. The mean postabortion ARR (0.63±0.74) was significantly increased (p=0.037) compared with the preconception year (0.50±0.71) as well as the postabortion mean number of new Gd+ lesions (0.77±1.40 vs 0.39±1.04; p=0.004). Higher likelihood of relapses was predicted by higher preconception ARR, discontinuation of preconception treatment and elective abortion; the occurrence of new Gd+ lesions was associated with higher preconception number of active lesions, discontinuation of preconception treatment, shorter length of pregnancy maintenance and elective abortion.

Conclusions Abortion was associated with clinical and radiological inflammatory rebound remarkably in the first 12 months postevent. Deregulated proinflammatory processes arising at the early stages of pregnancy might play a role both in MS reactivation and abortion. Women with MS should be counselled about these risks of abortion and followed up accordingly.

  • multiple sclerosis
  • abortion
  • pregnancy
  • annualised relapse rate
  • gadolinium enhancing lesion

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  • Contributors DL: Drafting of the manuscript content, including medical content; study concept or design; analysis or interpretation of data; acquisition of data. PR: Study concept or design; acquisition of data; analysis or interpretation of data; revising of the manuscript content. LP: Statistical analysis; analysis or interpretation of data; revising of the manuscript content. VN, SH, GS, CG: Acquisition of data; analysis or interpretation of data; revising of the manuscript content. AC, RF, SP, EF, MCB, GM, FM, MS, GD, AF, EM, MM, LB: Acquisition of data; analysis or interpretation of data. CP, DC: Revising of the manuscript content; study concept or design. GAM: Revising of the manuscript content; study concept or design; study supervision or coordination.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethic Committee of Tor Vergata Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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