Abstract Details

Title Pregnancy-related Relapses in a Large, Contemporary Multiple Sclerosis Cohort: No Increased Risk in the Postpartum Period

Topic Multiple Sclerosis

Presentation(s) S6 - MS and CNS Inflammatory Disease: Clinical Considerations I (2:06 PM-2:17 PM)

Poster/Presentation
Number 007

Background A decreased risk of relapse during pregnancy but significant rebound disease activity in the early postpartum period was reported in women with MS recruited from referral centers over 20 years ago prior to availability of disease-modifying treatments (DMTs) or MRIs to diagnosis patients with a single attack.

Objective To describe the risk of postpartum relapses and identify potentially modifiable risk factors in a contemporary multiple sclerosis (MS) cohort.

Design/Methods We identified 466 pregnancies among 375 women with MS from the complete electronic health record (EHR) at Kaiser Permanente Southern and Northern California between 2008-2016. We used prospectively collected information from EHR of mom and baby and interviewer-administered surveys to identify treatment history, breastfeeding and relapse and multivariable models to account for intraclass clustering and measures of disease severity.

Results 38.0% were not on any treatment in the year prior to conception, 14.6% had clinically isolated syndrome and 8.4% relapsed during pregnancy. In the postpartum year, 26.4% relapsed, 87% breastfed, 35% breastfed exclusively and 41.2% resumed DMTs. Annualized relapse rates (ARR) declined from 0.39 pre-pregnancy to 0.14-0.07 (p<0.0001) during pregnancy, but in the postpartum period we did not observe any rebound disease activity. ARR was slightly suppressed in the first 3-months postpartum (0.27, p=0.02), returning to pre-pregnancy rates at 4-6 months (0.37). Exclusive breastfeeding reduced the risk of postpartum relapses (adjusted HR=0.58, p=0.01) but resuming modestly effective DMTs had no effect (time-dependent covariate, p=0.86).

Conclusions Most women diagnosed with MS today can have children, breastfeed and resume modestly effective DMTs per their preferences without incurring an increased risk of relapses during the postpartum period. The lack of rebound disease activity in the early postpartum period is likely due to a combination of inclusion of women from a population-based setting, those diagnosed after a single relapse and high rates of exclusive breastfeeding.

Authors/Disclosures
Annette M. Langer-Gould, MD, PhD (Kaiser Permanente Southern California) PRESENTER	An immediate family member of Dr. Langer-Gould has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of American Thoracic Society. The institution of Dr. Langer-Gould has received research support from PCORI. The institution of an immediate family member of Dr. Langer-Gould has received research support from PCORI, ARQ, NIH. Dr. Langer-Gould has a non-compensated relationship as a Voting Member with ICER CTAF Panel that is relevant to AAN interests or activities.
Jessica B. Smith, MPH (Kaiser Permanente)	Ms. Smith has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Stephen K. Van Den Eeden, PhD (Kaiser Permanente)	Dr. Van Den Eeden has received personal compensation for serving as an employee of Kaiser Permanente Northern California. The institution of Dr. Van Den Eeden has received research support from NIH. The institution of Dr. Van Den Eeden has received research support from Biogen. The institution of Dr. Van Den Eeden has received research support from MJFF. The institution of an immediate family member of Dr. Van Den Eeden has received research support from NIH.

��ɫ��

��ɫ��