Pregnancy in multiple sclerosis in Baghdad 2024: a case control study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252382Keywords:
Pregnancy, Pregnancy complications, Multiple sclerosisAbstract
Background: Multiple sclerosis (MS) is an inflammatory demyelination illness affecting the central nervous system, with a higher prevalence in women, especially in childbearing age. Objectives of the study to measure pregnancy-related complications for both MS women and their newborns, to determine pregnancy's impact on MS relapses, and to evaluate the impact of disease-modifying therapies.
Methods: A case-control study that included 265 women with MS and their 265 matched controls. The study was conducted at Baghdad teaching hospital, medical city health directorate, and the AL-Saidyia primary health care center. All information was collected through the direct interviews by using a pre-prepared questionnaire from 15th March to December 2024; odds ratio (OR) was calculated, and a class interval that does not contain 1 is considered statistically significant.
Results: Pregnancy-related complications were reported in 27.5% of cases and 19.6% of controls. Miscarriages were significantly more common in the MS group (12.3% vs. 1.9%, OR 7.2, CI 2.78-18.89). Infants reported a total complication of 13.3% vs. 7.8%, with low birth weight (17%) as the most common complication in fetuses who were born to women with MS. Breastfeeding was less common in MS mothers (9.8% vs. 20.7%, p=0.001). Only 10.2% of MS patients continued disease modifying therapies (DMTs) (interferon beta) during pregnancy, with no significant link to adverse outcomes.
Conclusions: Pregnant women with MS and their fetuses experienced more complications like a higher rate of miscarriages and low birth weight. Interferons are not associated with adverse pregnancy outcomes. Multidisciplinary prenatal, natal, and postnatal care is essential for women with MS.
Metrics
References
Mohammed EMA. Understanding multiple sclerosis pathophysiology and current disease-modifying therapies: A review. Front Biosci. 2024;29(11):386. DOI: https://doi.org/10.31083/j.fbl2911386
Dobson R, Giovannoni G. Multiple sclerosis: A review. Eur J Neurol. 2019;26(1):27-40. DOI: https://doi.org/10.1111/ene.13819
Wang W, Li Y, Meng X. Vitamin D and neurodegenerative diseases. Heliyon. 2023;9(1):e12877. DOI: https://doi.org/10.1016/j.heliyon.2023.e12877
Verreycken J, Baeten P, Broux B. Regulatory T cell therapy for multiple sclerosis: Breaching (blood-brain) barriers. Hum Vacc Immunoth. 2022;18(7):2153534. DOI: https://doi.org/10.1080/21645515.2022.2153534
Sellner J, Kraus J, Awad A, Milo R, Hemmer B, Stüve O. The increasing incidence and prevalence of female multiple sclerosis-a critical analysis of potential environmental factors. Autoimmune Rev. 2011;10(8):495-502. DOI: https://doi.org/10.1016/j.autrev.2011.02.006
Angelini G, Bani A, Constantin G, Rossi B. The interplay between T helper cells and brain barriers in the pathogenesis of multiple sclerosis. Front Cellular Neurosci. 2023;17:1101379. DOI: https://doi.org/10.3389/fncel.2023.1101379
World Health Organization. Multiple sclerosis. Geneva: World Health Organization. 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/multiple-sclerosis. Accessed on 23 April 2025.
Naseri A, Nasiri E, Sahraian MA, Daneshvar S, Talebi M. Clinical features of late-onset multiple sclerosis: a systematic review and meta-analysis. Multiple Sclerosis and Related Disorders. 2021;50:102816. DOI: https://doi.org/10.1016/j.msard.2021.102816
Hassoun HK, Al-Mahadawi A, Sheaheed NM, Sami SM, Jamal A, and Allebban Z. Epidemiology of multiple sclerosis in Iraq: a retrospective review of 4355 cases and a literature review. Neurological Research. 2021;44(1):14-23. DOI: https://doi.org/10.1080/01616412.2021.1952511
Houtchens MK, Edwards NC, Schneider G, Stern K, Phillips AL. Pregnancy rates and outcomes in women with and without MS in the United States. Neurology. 2018 Oct 23;91(17):e1559-69. DOI: https://doi.org/10.1212/WNL.0000000000006384
LactMed. Interferon Beta. In: Drugs and Lactation Database [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2025.
Hakkarainen KM, Juuti R, Burkill S, et al. Pregnancy outcomes after exposure to interferon beta: a register-based cohort study among women with MS in Finland and Sweden. Ther Adv Neurol Disord. 2020;13:1756286420951072. DOI: https://doi.org/10.1177/1756286420951072
Krysko KM, Bove R, Dobson R, Jokubaitis V, Hellwig K. Treatment of women with multiple sclerosis planning pregnancy. Curr Treat Opt Neurol. 2021;23(4):11. DOI: https://doi.org/10.1007/s11940-021-00666-4
Chen Y, Lin H, Lin H. Does multiple sclerosis increase the risk of adverse pregnancy outcomes? A population-based study. Multiple Sclerosis J. 2009;15(5):606-12. DOI: https://doi.org/10.1177/1352458508101937
Novo A, Castelo J, de Sousa A, et al. Pregnancy outcomes in Portuguese women with multiple sclerosis: The PREGNIMS study. Multiple Sclerosis Rel Disord. 2019;28:172-6. DOI: https://doi.org/10.1016/j.msard.2018.12.033
Dahl J, Myhr KM, Daltveit AK, Gilhus NE. Pregnancy, delivery and birth outcome in different stages of maternal multiple sclerosis. J Neurol. 2008;255(5):623-7. DOI: https://doi.org/10.1007/s00415-008-0757-2
Fong A, Chau CT, Quant C, Duffy J, Pan D, Ogunyemi DA. Multiple sclerosis in pregnancy: prevalence, sociodemographic features, and obstetrical outcomes. J Maternal-Fetal Neonatal Med. 2018;31(3):382-7. DOI: https://doi.org/10.1080/14767058.2017.1286314
Sandberg-Wollheim M, Frank D, Goodwin T, Giesser B, Lopez-Bresnahan M, Stam-Moraga M, et al. Pregnancy outcomes during treatment with interferon beta-1a in patients with multiple sclerosis. Neurology. 2005;65(6):802-6. DOI: https://doi.org/10.1212/01.wnl.0000168905.97207.d0
Bove R, Alwan S, Friedman JM, Hellwig K, Houtchens M, Koren G, et al. Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstet Gynecol. 2014;124(6):1157-68. DOI: https://doi.org/10.1097/AOG.0000000000000541
Bouzaglou A, Aubenas I, Abbou H, Rouanet S, Carbonnel M, Pirtea P, et al. Pregnancy at 40 years old and above: obstetrical, fetal, and neonatal outcomes. Is age an independent risk factor for those complications? Front Med (Lausanne). 2020;7:208. DOI: https://doi.org/10.3389/fmed.2020.00208
World Health Organization. Why we need to talk about losing a baby. Geneva: World Health Organization. 2023. Available at: https://www.who.int/news-room/spotlight/why-we-need-to-talk-about-losing-a-baby. Accessed on 23 April 2025.
World Health Organization. Diabetes. Geneva: World Health Organization. 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes. Accessed on 23 April 2025.
Sinha P, Kuruba N. Ante-partum hemorrhage: an update. J Obstet Gynae Col. 2008;28(4):377-81. DOI: https://doi.org/10.1080/01443610802091487
Zhu Y, Zhang J, Li Q, Lin M. Association between gestational weight gain and preterm birth and post-term birth: a longitudinal study from the National Vital Statistics System database. BMC Pediatric. 2023;23(1):127. DOI: https://doi.org/10.1186/s12887-023-03951-0
World Health Organization. Low birth weight. Geneva: World Health Organization. Available at: https://www.who.int/data/nutrition/nlis/info/low-birth-weight. Accessed on 23 April 2025.
MacDonald SC, McElrath TF, Hernández-Díaz S. Pregnancy outcomes in women with multiple sclerosis. Am J Epidemiol. 2019;188(1):57-66. DOI: https://doi.org/10.1093/aje/kwy197
Simone IL, Tortorella C, Ghirelli A. Influence of pregnancy in multiple sclerosis and impact of disease-modifying therapies. Front Neurol. 2021;12:697974.
Gitman V, Stavropoulos A, Saenz V, Pasquarelli N, Zecevic D, Devonshire V. Pregnancy outcomes of women with multiple sclerosis treated with ocrelizumab in Canada: A descriptive analysis of real-world data. Multiple Sclerosis Rel Disord. 2022;62:103792. DOI: https://doi.org/10.1016/j.msard.2022.103792
Lopez-Leon S, Geissbühler Y, Sabidó M, Turkson M, Wahlich C, Morris JK. A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 Conception project. J Neurol. 2020;267(9):2721-31. DOI: https://doi.org/10.1007/s00415-020-09913-1
Sadovnick D, Criscuoli M, Yee I, Carruthers R, Schabas A, Devonshire V, et al The Canadian Multiple Sclerosis Pregnancy Study: First-trimester miscarriages in women with multiple sclerosis. Multiple Sclerosis J. 2023;29(3):407-14. DOI: https://doi.org/10.1177/13524585221146270
Cornish EF, McDonnell T, Williams DJ. Chronic inflammatory placental disorders associated with recurrent adverse pregnancy outcome. Front Immunol. 2022;13:825075. DOI: https://doi.org/10.3389/fimmu.2022.825075
Yang F, Zheng Q, Jin L. Dynamic function and composition changes of immune cells during normal and pathological pregnancy at the maternal-fetal interface. Front Immunol. 2019;10:2317. DOI: https://doi.org/10.3389/fimmu.2019.02317
Simone IL, Tortorella C, Ghirelli A. Influence of pregnancy in multiple sclerosis and impact of disease-modifying therapies. Front Neurol. 2021;12:697974. DOI: https://doi.org/10.3389/fneur.2021.697974
Aguilar-Zafra S, Del Corral T, Vidal-Quevedo C, Rodríguez-Durán P, López-de-Uralde-Villanueva I. Pelvic floor dysfunction negatively impacts general functional performance in patients with multiple sclerosis. Neurotol Urodynamics. 2020;39(3):978-86. DOI: https://doi.org/10.1002/nau.24314
Mohammed AK. A cross-sectional analytic study on rate and indication of caesarean section in Sulaymaniyah City, Republic of Iraq: A study from the perspective of women health behavior. Am J Health Behavior. 2023;47(4):14. DOI: https://doi.org/10.5993/AJHB.47.4.14
Dubuisson N, de Maere d'Aertrijcke O, Marta M, Gnanapavan S, Turner B, Baker D, et al. Anesthetic management of people with multiple sclerosis. Multiple Sclerosis and Related Disorders. 2023;80:105045. DOI: https://doi.org/10.1016/j.msard.2023.105045
Moccia M, Affinito G, Fumo MG, Giordana R, Di Gennaro M, Mercogliano M, et al. Fertility, pregnancy and childbirth in women with MS. J Neurol Neurosurg Psychiatry. 2023;94(9):689-97. DOI: https://doi.org/10.1136/jnnp-2022-330883
Almas S, Vance J, Baker T, Hale T. Management of Multiple Sclerosis in the Breastfeeding Mother. Multiple Sclerosis Int. 2016;2016:1-10. DOI: https://doi.org/10.1155/2016/6527458