TY - JOUR
T1 - Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses
T2 - The Italian cohort study
AU - Pastò, Luisa
AU - Portaccio, Emilio
AU - Ghezzi, Angelo
AU - Hakiki, Bahia
AU - Giannini, Marta
AU - Razzolini, Lorenzo
AU - Piscolla, Elisa
AU - De Giglio, Laura
AU - Pozzilli, Carlo
AU - Paolicelli, Damiano
AU - Trojano, Maria
AU - Marrosu, Maria Giovanna
AU - Patti, Francesco
AU - La Mantia, Loredana
AU - Mancardi, Gian Luigi
AU - Solaro, Claudio
AU - Totaro, Rocco
AU - Tola, Maria Rosaria
AU - Di Tommaso, Valeria
AU - Lugaresi, Alessandra
AU - Moiola, Lucia
AU - Martinelli, Vittorio
AU - Comi, Giancarlo
AU - Amato, Maria Pia
PY - 2012/12/31
Y1 - 2012/12/31
N2 - Background: Few studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women with Multiple Sclerosis (MS).The objective of this study was to assess the impact of epidural analgesia (EA) and caesarean delivery (CD) on the risk of post-partum relapses and disability in women with MS.Methods: In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and EA. The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis.Results: We collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5±3.1 years). One hundred and fifty-five patients (44.4%) underwent CD and 65 (18.5%) EA. In the multivariate analysis neither CD, nor EA were associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95% CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95% CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, CD and EA were not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95% CI 2.0-8.2; p
AB - Background: Few studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women with Multiple Sclerosis (MS).The objective of this study was to assess the impact of epidural analgesia (EA) and caesarean delivery (CD) on the risk of post-partum relapses and disability in women with MS.Methods: In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and EA. The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis.Results: We collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5±3.1 years). One hundred and fifty-five patients (44.4%) underwent CD and 65 (18.5%) EA. In the multivariate analysis neither CD, nor EA were associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95% CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95% CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, CD and EA were not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95% CI 2.0-8.2; p
KW - Caesarean delivery
KW - Epidural analgesia
KW - Multiple sclerosis
KW - Pregnancy
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U2 - 10.1186/1471-2377-12-165
DO - 10.1186/1471-2377-12-165
M3 - Article
C2 - 23276328
AN - SCOPUS:84871675346
SN - 1471-2377
VL - 12
JO - BMC Neurology
JF - BMC Neurology
M1 - 165
ER -