title: Elevated concentration of C-reactive protein is associated with pregnancy-related co-morbidities but not with relapse activity in multiple sclerosis.
abstract: During pregnancy, alterations take place in mother's immune system with the goal of maintaining a successful pregnancy, and delivering healthy offspring. Immune alterations include activation of the innate immune system and dampening of cell-mediated adaptive immunity. Due to these alterations, cell-mediated autoimmune diseases typically ameliorate during pregnancy. The objectives of this study were to evaluate whether C-reactive protein (CRP) concentration, a sensitive marker of systemic inflammation (1) is increased during MS pregnancy (2) predicts pregnancy-related co-morbidities associated with MS (3) predicts MS disease activity after delivery. CRP concentration was measured using a high sensitivity assay from seven prospectively collected serum samples of 41 MS patients and 19 controls during pregnancy and 6 months after delivery. Annualized relapse rates, EDSS, fatigue scores and obstetric details of the patients were recorded. Delivery-related CRP levels were significantly elevated both among MS patients and in controls. CRP levels were higher during pregnancy than during the postpartum period in both study groups. Delivery-related elevated CRP levels did not correlate with postpartum disease activity. MS patients with eventual gestational diabetes had a significantly higher median CRP in the beginning of pregnancy compared to non-diabetic MS patients (9.28 vs. 2.98 mg/l, p = 0.0025). MS patients reporting fatigue had a significantly higher CRP throughout pregnancy compared to patients without fatigue. Higher CRP values were associated with pregnancy-related co-morbidities but not with MS disease activity.
authors.affiliation: Division of Clinical Neurosciences, Turku University Hospital, PL 52, 20521, Turku, Finland, anna.jalkanen@utu.fi.
authors.forename: Anna
authors.initials: A
authors.lastname: Jalkanen
authors.forename: Tommi
authors.initials: T
authors.lastname: Kauko
authors.forename: Janne O
authors.initials: JO
authors.lastname: Koskinen
authors.forename: Matti E
authors.initials: ME
authors.lastname: Waris
authors.forename: Laura
authors.initials: L
authors.lastname: Airas
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis*; D015897:Comorbidity; D048909:Diabetes Complications / Q000097:blood; D005221:Fatigue / Q000150:complications; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000097:blood / Q000150:complications*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D012008:Recurrence; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein