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. 2012 Dec 31:12:165.
doi: 10.1186/1471-2377-12-165.

Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study

Luisa Pastò  1 , Emilio Portaccio, Angelo Ghezzi, Bahia Hakiki, Marta Giannini, Lorenzo Razzolini, Elisa Piscolla, Laura De Giglio, Carlo Pozzilli, Damiano Paolicelli, Maria Trojano, Maria Giovanna Marrosu, Francesco Patti, Loredana La Mantia, Gian Luigi Mancardi, Claudio Solaro, Rocco Totaro, Maria Rosaria Tola, Valeria Di Tommaso, Alessandra Lugaresi, Lucia Moiola, Vittorio Martinelli, Giancarlo Comi, Maria Pia Amato; MS Study Group of the Italian Neurological Society
Affiliations

Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study

Luisa Pastò et al. BMC Neurol. .

Abstract

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<0.001; disability progression over the whole follow-up period: OR= 2.0; 95% CI 1.2-3.3; p=0.005).

Conclusions: Our findings, show no correlation between EA, CD and postpartum relapses and disability. Therefore these procedures can safely be applied in MS patients. On the other hand, post-partum relapses are significantly associated with increased disability, which calls for the need of preventive therapies after delivery.

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Figures

Figure 1
Figure 1
Flow-chart of the pregnancies enrolled in the study.
Figure 2
Figure 2
Annualized relapse-rate before, during and after pregnancy in patients who underwent CD(left)and patients who underwent EA(right). CD: Caesarean Delivery, EA: Epidural analgesia.
See this image and copyright information in PMC

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