PT  - JOURNAL ARTICLE
AU  - Emilio Portaccio
AU  - Angelo Ghezzi
AU  - Bahia Hakiki
AU  - Andrea Sturchio
AU  - Vittorio Martinelli
AU  - Lucia Moiola
AU  - Francesco Patti
AU  - Gian Luigi Mancardi
AU  - Claudio Solaro
AU  - Maria Rosaria Tola
AU  - Carlo Pozzilli
AU  - Laura De Giglio
AU  - Rocco Totaro
AU  - Alessandra Lugaresi
AU  - Giovanna De Luca
AU  - Damiano Paolicelli
AU  - Maria Giovanna Marrosu
AU  - Giancarlo Comi
AU  - Maria Trojano
AU  - Maria Pia Amato
AU  - for the MS Study Group of the Italian Neurological Society
TI  - Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs
AID  - 10.1136/jnnp-2013-306054
DP  - 2014 Aug 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 845--850
VI  - 85
IP  - 8
4099  - http://jnnp.bmj.com/content/85/8/845.short
4100  - http://jnnp.bmj.com/content/85/8/845.full
SO  - J Neurol Neurosurg Psychiatry2014 Aug 01; 85
AB  - 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.