New research suggests that even though pregnant women with multiple sclerosis (MS) are often viewed as high-risk by their physicians, pregnancy does not seem to increase the likelihood of adverse obstetrical outcomes for those patients or their babies.
The research was presented at the 2019 Annual Meeting of the American Academy of Neurology (AAN) in Philadelphia (May 4–10), in an oral presentation titled “Pregnancies in Women with Multiple Sclerosis: Perception of High Risk Among Health Care Providers. Interim Data from PREG-MS Cohort.“
According to the researchers at Brigham and Women’s Hospital in Boston, Massachusetts, up to a third of female MS patients become pregnant after disease onset. Because some MS disease-modifying therapies (DMTs) have the potential to cause complications during pregnancy, it is recommended that MS patients planning to become pregnant discontinue the therapies prior to conception.
However, “there is no published data to suggest that pregnancies in MS patients should be considered an obstetrical high risk due to neurologic condition alone,” the researchers noted.
The team analyzed early results from the PREG-MS study — the New England MS Pregnancy Registry (NCT03368157). PREG-MS’s goal is to follow female MS patients in the United States who are actively trying to conceive; participants are followed from conception to three years after giving birth. The course of the patients’ disease and pregnancies are collected via phone interviews, and are validated with medical records. (The trial is still recruiting eligible patients.)
According to the team, 70 women in the program are currently pregnant or have delivered. These patients had an average Expanded Disability Status Scale score of 0.92, indicating a low disability level.
In 16 of the pregnancies reported, there was exposure to DMTs early on, and two patients remained on treatment with glatiramer acetate (marketed as Copaxone by Teva Pharmaceuticals, among other generic therapies) throughout their pregnancies.
Forty-nine of the pregnancies were considered high-risk by clinicians — seven due to early DMT exposure, 17 due to MS diagnosis alone, and 25 due to factors unrelated to MS.
Notably, however, pregnancies labeled “high-risk” due to MS only did not actually appear to be so, as this label was not predictive of obstetric complications during pregnancy/delivery, or of adverse events in the babies born. Furthermore, patients with this label were not at a greater risk to experience disease relapse during or after pregnancy, with up to nine months of follow-up.
Overall, the results suggest that healthcare providers may have misconceptions about the possible risks involved in pregnancy in women with MS.
“PREG-MS dataset analysis suggests a possible misperception of MS pregnancy risk and course among healthcare providers,” the researchers wrote.
According to them, although there is data suggesting that DMT exposure can be problematic during pregnancy, the “MS diagnosis itself does not appear to imply adverse pregnancy outcomes in our prospective cohort,” the team concluded.