Pregnancy Outcomes in Women with Multiple Sclerosis

Abstract

Few studies have assessed the risk for adverse pregnancy outcomes in women with multiple sclerosis (MS). We used two large United States administrative databases (2011-2015 Truven Health Marketscan® Database; 2007-2011 Nationwide Inpatient Sample) to identify delivery cohorts. MS and pregnancy outcomes (infections, Cesarean section, preterm delivery, poor fetal growth, preeclampsia, chorioamnionitis, postpartum hemorrhage, stillbirth, infant malformations) were identified during pregnancy and at delivery. We calculated adjusted risk ratios by MS status and relapses in the year before delivery. Among over 5 million pregnancies, we identified 3,875 in women with MS. Women with MS had an increased risk of infections during pregnancy (adjusted risk ratio Truven: 1.22 [95% confidence interval {CI}: 1.16, 1.27]) and preterm delivery (Truven 1.19 [95% CI: 1.04, 1.35]; Nationwide Inpatient Sample 1.30 [95% CI: 1.16, 1.44]). The risk of other outcomes was similar for women with and without MS. In Truven, risk ratios of the pregnancy outcomes in women experiencing relapses versus those without relapses were between 0.9 and 1.4, and confidence intervals overlapped the null. Overall, women with MS had an increased risk of infections and preterm delivery, however, their risks for other adverse pregnancy outcomes were not elevated. Disease activity before delivery was not a strong predictor of outcomes.