Pregnancy outcomes in Lebanese women with multiple sclerosis (the LeMS study): a prospective multicentre study

Abstract

Objective: The Lebanese Multiple Sclerosis (LeMS) study aims to assess the influence of pregnancy and delivery on the clinical course of multiple sclerosis (MS) in Lebanese women.

Setting: This prospective multicentre study took place in three MS referral university medical centres in Lebanon.

Participants: Included were 29 women over 18 years who had been diagnosed with MS according to the McDonald criteria, and became pregnant between 1995 and 2015. Participating women should have stopped treatment 3 months before conception and become pregnant after the onset of MS. Women were followed up from 1 year preconceptionally and for 4 years postpartum.

Main outcome measures: The annualised relapse rates per participant during each 3-month period during pregnancy and each year postpartum were compared with the relapse rate during the year before pregnancy using the paired two-tailed t test. p Values <0.05 were considered statistically significant for all analyses (95% CI).

Results: 64 full-term pregnancies were recorded. All pregnancies (100%) resulted in live births, with no complications or other diseases. In comparison with the prepregnancy year, in which the mean relapse rate±SE was 0.17±0.07, there was a significant reduction in the relapse rate during pregnancy and in the first year postpartum (p=0.02), but an increase in the rate in the second year postpartum (0.21±0.08). Thereafter, from the third year postpartum through the following fourth year, the annualised relapse rate fell slightly but did not differ from the annualised relapse rate recorded in the prepregnancy year (0.17±0.07).

Conclusions: Pregnancy in Lebanese women with MS does not seem to increase the risk of complications. No relapses were observed during pregnancy and in the first year postpartum; however, relapses rebounded in the second year postpartum, and over the long term, returned to the levels that preceded pregnancy.

Keywords: Interferon beta; Management; Outcomes; Pregnancy; Relapse.

Figure 1

Annualised relapse rate in the year before pregnancy, during pregnancy, and in the four years after delivery among the 29 women with MS (vertical bars represent means and standard errors of means; * signifies p<0.05 for annualised relapse rate when compared to the year before pregnancy). MS, multiple sclerosis.