title: Does pregnancy alter the long-term course of multiple sclerosis?
abstract: OBJECTIVE
  The purpose was to examine the impact of pregnancy on the rates of relapses, progression to irreversible disability, and transition to secondary progressive multiple sclerosis (SPMS) in patients with relapsing-remitting multiple sclerosis (RRMS).
  
  
  METHODS
  We retrospectively followed two subcohorts of women with RRMS: pregnant (n = 254) and nonpregnant (n = 423). We obtained data on demographic, lifestyle, and clinical characteristics from patient records. Poisson and logistic regressions estimated the rate ratios associated with pregnancy as a function of time. Confounding was controlled by propensity-score adjustment, and postbaseline selection bias was controlled by inverse probability weighting.
  
  
  RESULTS
  In the pregnant and nonpregnant subcohorts, respectively, 300 and 787 relapses, 15 and 27 transitions to SPMS, and 11 and 34 progressions to irreversible disability were documented. Adjusted rate ratios (95% confidence intervals) shortly after baseline were 0.67 (0.49; 0.92) for relapses, 0.16 (0.03; 0.79) for irreversible disability, and 1.25 (0.39; 3.96) for SPMS. The corresponding estimates at 5 and 10 years were, respectively, 1.04 (0.72; 1.52), 0.82 (0.36; 1.88), and 2.33 (1.03; 5.26) and 1.62 (0.84; 3.14), 4.14 (0.89; 19.22), and 4.33 (1.10; 16.99).
  
  
  CONCLUSIONS
  Pregnancy likely ameliorates the short-term course of RRMS in terms of the rates of relapses and progression to irreversible disability. Over the long term, it appears to have no material impact on these outcomes, and might in fact accelerate the rate of transition to SPMS.
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal, (CRCHUM), Montréal, Québec, Canada; Département de médecine sociale et préventive, Université de Montréal, Montréal, Québec, Canada. Electronic address: igor.karp.1@umontreal.ca.
authors.forename: Igor
authors.initials: I
authors.lastname: Karp
authors.affiliation: Université de Montréal, Montréal, Québec, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Manganas
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal, (CRCHUM), Montréal, Québec, Canada; Département de médecine sociale et préventive, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Sylvestre
authors.affiliation: Université de Montréal, Montréal, Québec, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Ho
authors.affiliation: MS Clinic, Hôpital Notre-Dame du CHUM, Montréal, Québec, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Roger
authors.affiliation: MS Clinic, Hôpital Notre-Dame du CHUM, Montréal, Québec, Canada; Faculté de Médecine (Neurology), Université de Montréal, Montréal, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Duquette
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis / Q000503:physiopathology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000503:physiopathology*; D011247:Pregnancy / Q000502:physiology; D011248:Pregnancy Complications / Q000276:immunology*; D057216:Propensity Score; D012008:Recurrence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Cohort; Epidemiology; Longitudinal studies; Multiple sclerosis; Pregnancy; Prognosis