title: Obstetrical epidural and spinal anesthesia in multiple sclerosis.
abstract: To examine obstetrical epidural and spinal anesthesia use in women with multiple sclerosis (MS) and the relationship with MS clinical factors. This was a retrospective cohort study, linking clinical data from women with MS in the British Columbia (BC) MS database to obstetrical data (1998-2009) from the BC Perinatal Database Registry. We compared epidural use in 431 deliveries to women with MS and 2,959 deliveries from the general population, as well as spinal use in cesarean deliveries (128 to women with MS and 846 in the general population), considering parity and using multivariate models. We also examined the association between epidural or spinal anesthesia and MS clinical factors-disease duration and disability [Expanded Disability Status Scale (EDSS) score]. Of 431 deliveries to women with MS, 116 were exposed to epidural anesthesia and of 128 cesarean deliveries, 82 were exposed to spinal anesthesia. The use of epidural anesthesia was similar in nullipara (adjusted OR = 0.86, 95 % CI = 0.63-1.18, p = 0.36), but more likely in multipara with MS (adjusted OR = 1.75, 95 % CI = 1.20-2.54, p = 0.004). Spinal anesthesia use in cesarean deliveries was comparable between the MS and general population cohorts (adjusted OR = 0.84, 95 % CI = 0.55-1.31, p = 0.45). Women who delivered 5 to <10 years after MS onset were less likely to have an epidural (adjusted OR = 0.57, 95 % CI = 0.34-0.95, p = 0.03) vs. those delivering within 5 years. EDSS was not associated with use of either type of anesthesia (adjusted p > 0.1). Contrary to previous studies, epidural anesthesia use differed between women with MS and the general population and was influenced by parity and MS disease duration; these findings warrant further investigation.
authors.affiliation: Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Room S178, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
authors.forename: Ellen
authors.initials: E
authors.lastname: Lu
authors.forename: Yinshan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Leanne
authors.initials: L
authors.lastname: Dahlgren
authors.forename: Roanne
authors.initials: R
authors.lastname: Preston
authors.forename: Mia
authors.initials: M
authors.lastname: van der Kop
authors.forename: Anne
authors.initials: A
authors.lastname: Synnes
authors.forename: A Dessa
authors.initials: AD
authors.lastname: Sadovnick
authors.forename: Anthony
authors.initials: A
authors.lastname: Traboulsee
authors.forename: Helen
authors.initials: H
authors.lastname: Tremlett
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001955:British Columbia / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D055815:Young Adult