Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study).
BACKGROUND
The influence of pregnancy on Multiple Sclerosis (MS) has been extensively studied but such influence on Latin American women with MS has not been characterized. Our objective was to describe the course of pregnancy and birth outcome in Argentinean MS patients and the evolution of MS during pregnancy and after delivery.


METHODS
We used a retrospective design in eight MS centers in Argentina and administered a survey to women with definite MS (Mc Donald) with pregnancies during or after MS onset. We contacted 355 women of which 81 met inclusion criteria. We recorded 141 pregnancies.


RESULTS
Involuntary abortion was observed in 16% of pregnancies (95% CI = 10-23). Thirty five women received immunomodulatory therapy (IMT) before 42 pregnancies. Twenty three (55%) out of 42 pregnancies were exposed to IMT. The mean time of IMT discontinuation before conception in 19 (45.2%) pregnancies without exposure, was 104 days (95% CI = 61.0-147.0). There were 103 deliveries: 79% full term. Birth defects were detected in 19% of pregnancies exposed to IMT (95% CI = 4-46) and in 2% of non-exposed (95% CI = 0.3-8.0). The mean relapse rate was: pre-pregnancy year: 0.22 (95% CI = 0.12-0.32); pregnancy: 0.31 in 1st (95% CI = 0.10-0.52), 0.19 (95% CI = 0.03-0.36) in 2nd, and 0.04 in 3rd trimester (95% CI = -0.04-0.12); 1st trimester post delivery: 0.82 (95% CI = 0.42-1.22).


CONCLUSIONS
We observed a higher rate of birth defects among infants exposed to immunomodulators in utero than those not exposed. The reduction in MS relapses during 2nd and 3rd trimester of pregnancy and its increase during postpartum is consistent with previous reports.
Fernández Liguori
N
N
Multiple Sclerosis Section Hospital E.Tornú, Buenos Aires, Argentina. nfliguori@gmail.com
Klajn
D
D
Acion
L
L
Cáceres
F
F
Calle
A
A
Carrá
A
A
Cristiano
E
E
Deri
N
N
Garcea
O
O
Jaureguiberry
A
A
Onaha
P
P
Patrucco
L
L
Riccio
P
P
Rotta Escalante
R
R
Saladino
M l
Ml
Sinay
V
V
Tarulla
A
A
Villa
A
A
D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D001942:Breast Feeding / Q000706:statistics & numerical data; D000013:Congenital Abnormalities / Q000453:epidemiology*; D003625:Data Collection; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000453:epidemiology*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D007166:Immunosuppressive Agents