Disease Progression and Obstetric Outcomes of Women with Multiple Sclerosis at a Reference Center in Northeastern Brazil

Abstract Objective To describe the obstetric outcomes of patients withmultiple sclerosis (MS) and the impact of pregnancy and the postpartum period on the progression of the disease. Methods A case series study performed between December 2019 and February 2020, reporting pregnancies occurred between 1996 and 2019. The subjects included were women with MS undergoing follow-up at an MS referral center in Northeastern Brazil, and who had at least one pregnancy after the onset of MS symptoms, or who had their first relapse in the first year after delivery. Results In total, 26 women and 38 pregnancies were analyzed - 32 of them resulted in delivery, and the remaining 6, in miscarriages. There was a significant increase in the prevalence of relapse during the postpartum period when compared with the gestational period. In 16 (42.1%) of the pregnancies, there was exposure to diseasemodifying therapies (DMTs) - 14 (36.8%), to interferon β, and 2 (5.3%), to fingolimod. Higher rates of abortion, prematurity and low birth weight were reported in the group was exposed to DMT when compared with the one who was not. Conclusion In the sample of the present study, there was a significant increase in the rate of MS relapse during the postpartum period when compared with the gestational period. Additionally, it seems that exposure to DMTs during pregnancy may affect the obstetric outcomes of the patients.

摘要 目的：描述多发性硬化（multiple sclerosis, MS）患者的产科结局，以及妊娠与产后时期对疾病进展的影响。
方法：本研究为病例系列研究，于2019年12月至2020年2月期间开展，纳入1996年至2019年间发生的所有妊娠病例。研究对象为巴西东北部某多发性硬化转诊中心接受随访的女性多发性硬化患者，且满足以下任一条件：多发性硬化症状发作后至少有过一次妊娠史，或在分娩后一年内首次出现疾病复发。
结果：共纳入26名女性患者，涉及38次妊娠，其中32次以分娩告终，剩余6次为流产。与妊娠期间相比，产后时期的疾病复发率显著升高。在16次（42.1%）妊娠中，患者接受了疾病修正治疗（disease-modifying therapies, DMTs）：14次（36.8%）使用干扰素β，2次（5.3%）使用芬戈莫德。与未接受疾病修正治疗的患者组相比，接受治疗组的流产、早产及低出生体重发生率更高。
结论：在本研究的样本中，产后时期的多发性硬化复发率显著高于妊娠期间。此外，妊娠期间暴露于疾病修正治疗可能会对患者的产科结局产生不利影响。