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Cited by 1,559Multiple Sclerosis Research StudiesPregnancy and Medication ImpactMaternal Mental Health During Pregnancy and Postpartum

Rate of Pregnancy-Related Relapse in Multiple Sclerosis

Open access
Confavreux, Christian, Hutchinson, Michael, Hours, Martine Marie, Cortinovis-Tourniaire, Patricia, Moreau, Thibault·1998·New England Journal of Medicine
DOI 10.1056/nejm199807303390501
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Abstract

BACKGROUND AND METHODS: Multiple sclerosis often occurs in young women, and the effect of pregnancy on the disease is poorly understood. We studied 254 women with multiple sclerosis during 269 pregnancies in 12 European countries. The women were followed during their pregnancies and for up to 12 months after delivery to determine the rate of relapse per trimester and the score on the Kurtzke Expanded Disability Status Scale (range, 0 to 10, with higher scores indicating more severe disability). The relapse rate in each trimester was compared with the rate during the year before the pregnancy. The effects of epidural analgesia and breast-feeding on the frequency of relapse during the first three months post partum and the disability score at 12 months post partum were also determined. RESULTS: The mean (+/-SD) rate of relapse was 0.7+/-0.9 per woman per year in the year before pregnancy; it was 0.5+/-1.3 during the first trimester (P=0.03 for the comparison with the rate before pregnancy), 0.6+/-1.6 during the second trimester (P=0.17), and 0.2+/-1.0 during the third (P<0.001). The rate increased to 1.2+/-2.0 during the first three months post partum (P<0.001) and then returned to the prepregnancy rate. The mean Kurtzke disability score worsened by 0.7 point during 33 months of follow-up, with no apparent acceleration during the post-partum period. Neither breast-feeding nor epidural analgesia had an adverse effect on the rate of relapse or on the progression of disability in multiple sclerosis. CONCLUSIONS: In women with multiple sclerosis, the rate of relapse declines during pregnancy, especially in the third trimester, and increases during the first three months post partum before returning to the prepregnancy rate.

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  • In MS there is a clear protection from relapse during the third trimester of pregnancy when several hormones, especially sex steroids, reach a peak.

    “In MS there is a clear protection from relapse during the third trimester of pregnancy when several hormones, especially sex steroids, reach a peak (12).”

    From SJL Mice Exposed to Cuprizone Intoxication Reveal Strain and Gender Pattern Differences in Demyelination (2009) · cites this paper as [12]

    The Results and Conclusions report that relapse rates in women with MS declined especially in the third trimester. The paper’s discussion proposes an immunologic explanation, but the passages in our copy do not say that hormones, particularly sex steroids, peak then; searches for those terms found no support for that part of the sentence. Page numbers were not provided for these passages. (LLM, conf=0.86)

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Cites

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Cited by

Sorted by citations

Authors
Confavreux, C., Hutchinson, M., Hours, M. M., Cortinovis-Tourniaire, P., & Moreau, T.
Affiliations
  • Hospices Civils de Lyon (FR)
  • St. Vincent's University Hospital (IE)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1998-07-30
Volume
339
Issue
5
Pages
285-291
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199807303390501
OpenAlex
W2319459971
Cited by
1,559
References
2
Citations by year
2026: 43 · 2025: 48 · 2024: 60 · 2023: 62 · 2022: 63 · 2021: 71 · 2020: 80 · 2019: 72 · 2018: 74 · 2017: 55 · 2016: 56 · 2015: 83 · 2014: 71 · 2013: 72 · 2012: 73
FWCI
16.20
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
multiple sclerosis, pregnancy, relapse rate, postpartum period, pregnancy trimesters, disability progression, Expanded Disability Status Scale, epidural analgesia, breastfeeding, postpartum relapse
MeSH terms
Adult, Breast Feeding, Female, Humans, Multiple Sclerosis, Pregnancy, Pregnancy Complications, Prospective Studies, Recurrence, Analgesia, Epidural, Analgesia, Obstetrical, Disease Progression, Postpartum Period

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