Sars-CoV2 infection in pregnant women with multiple sclerosis

Maria Grazia Aprea¹, Irene Schiavetti², Emilio Portaccio¹, Chiara Ballerini¹, Mario Alberto Battaglia³, Roberto Bergamaschi⁴, Giampaolo Brichetto⁵, S Destan Bunul⁶, Massimiliano Calabrese⁷, Marco Capobianco⁸, Paola Cavalla⁹, Maria Grazia Celani¹⁰, Marinella Clerico¹¹, Eleonora Cocco¹², Giancarlo Comi¹³, Paolo Confalonieri¹⁴, Antonella Conte¹⁵, Cinzia Cordioli¹⁶, Giovanna De Luca¹⁷, Nicola De Rossi¹⁶, Massimo Filippi¹⁸, Haluk Gumes¹⁹, Paolo Immovilli²⁰, Matilde Inglese²¹, Rana Karabudak²², Doriana Landi²³, Roberta Lanzillo²⁴, Maria Rita L'Episcopo²⁵, Lorena Lorefice¹², Vittorio Mantero²⁶, Sabrina Marangoni²⁷, Girolama Alessandra Marfia²³, Camilla Masciulli¹, Eva Milano²⁸, Lucia Moiola²⁹, Riccardo Orlandi³⁰, Francesco Patti³¹, Paola Perini³², Ilaria Pesci³³, Eugenio Pucci³⁴, Marco Puthenparampil³², Marta Radaelli¹², Marco Salvetti³⁵, Arianna Sartori³⁶, Cinzia Scandellari³⁷, Sedat Sen³⁸, Aksel Siva³⁹, Silvia Strumia⁴⁰, Francesco Teatini⁴¹, Gioacchino Tedeschi⁴², Maria Trojano⁴³, Melih Tutuncu³⁹, Giovanna Vaula⁴⁴, Maria Pia Sormani⁴⁵, Maria Pia Amato⁴⁶; Musc-19 Study Group

Affiliations

¹ Department of NEUROFARBA, University of Florence, Florence, Italy.
² Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy.
³ Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy/Department of Life Sciences, University of Siena, Siena, Italy.
⁴ Multiple Sclerosis Center, IRCCS Mondino Foundation, Pavia, Italy.
⁵ Italian Multiple Sclerosis Society Foundation, Genova, Italy.
⁶ Kocaeli University School of Medicine, Kocaeli, Kocaeli, Turkey.
⁷ The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy.
⁸ Department of Neurology, Santa Croce and Carle Hospital, Cuneo, Italy.
⁹ MS Center, Department of Neuroscience, City of Health and Science, University Hospital of Turin, Turin, Italy.
¹⁰ Servizio Malattie Demielinizzanti, SC di Neurofisiopatologia, AO di Perugia, Perugia, UK.
¹¹ Clinical and Biological Sciences Department, University of Turin, Turin, Italy.
¹² Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy.
¹³ Università Vita-Salute San Raffaele, Milan, Italy.
¹⁴ Multiple Sclerosis Centre, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy.
¹⁵ Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy.
¹⁶ Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy.
¹⁷ MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy.
¹⁸ Neurology Unit and MS Center, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
¹⁹ Selcuk University School of Medicine, Konya, Turkey.
²⁰ Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy.
²¹ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy.
²² Hacettepe University School of Medicine, Ankara, Turkey.
²³ Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
²⁴ Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy/Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy.
²⁵ Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy.
²⁶ UOC Neurologia-Stroke Unit, Presidio "A. Manzoni," ASST Lecco, Italy/Department of Neurology, Ospedale Santa Chiara, Trento, Italy.
²⁷ Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, "Tor Vergata" University, Rome, Italy.
²⁸ SC Neurologia 1, Ospedale Maria Vittoria, Torino, Italy.
²⁹ Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy.
³⁰ Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
³¹ Department "GF Ingrassia" Section of Neurosciences, University of Catania, Catania, Italy.
³² Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy.
³³ Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy.
³⁴ UOC Neurologia, ASUR Marche, Fermo, Italy.
³⁵ IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy/Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.
³⁶ Neurology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Trieste, Italy.
³⁷ IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy.
³⁸ Ondokuz Mayis University School of Medicine, Samsun, Turkey.
³⁹ Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey.
⁴⁰ UOC di Neurologia, Ospedale Morgagni-Pierantoni, Forlì, Italy.
⁴¹ Multiple Sclerosis Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy.
⁴² Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
⁴³ Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy.
⁴⁴ Department of Neuroscience, Città della Salute e della Scienza University Hospital, Turin, Italy.
⁴⁵ Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy.
⁴⁶ Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.

PMID: 37232279
PMCID: PMC10225808
DOI: 10.1177/13524585231176174

Multicenter Study

Sars-CoV2 infection in pregnant women with multiple sclerosis

Maria Grazia Aprea et al. Mult Scler. 2023 Aug.

. 2023 Aug;29(9):1090-1098.

doi: 10.1177/13524585231176174. Epub 2023 May 26.

Authors

Affiliations

¹ Department of NEUROFARBA, University of Florence, Florence, Italy.
² Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy.
³ Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy/Department of Life Sciences, University of Siena, Siena, Italy.
⁴ Multiple Sclerosis Center, IRCCS Mondino Foundation, Pavia, Italy.
⁵ Italian Multiple Sclerosis Society Foundation, Genova, Italy.
⁶ Kocaeli University School of Medicine, Kocaeli, Kocaeli, Turkey.
⁷ The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy.
⁸ Department of Neurology, Santa Croce and Carle Hospital, Cuneo, Italy.
⁹ MS Center, Department of Neuroscience, City of Health and Science, University Hospital of Turin, Turin, Italy.
¹⁰ Servizio Malattie Demielinizzanti, SC di Neurofisiopatologia, AO di Perugia, Perugia, UK.
¹¹ Clinical and Biological Sciences Department, University of Turin, Turin, Italy.
¹² Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy.
¹³ Università Vita-Salute San Raffaele, Milan, Italy.
¹⁴ Multiple Sclerosis Centre, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy.
¹⁵ Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy.
¹⁶ Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy.
¹⁷ MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy.
¹⁸ Neurology Unit and MS Center, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
¹⁹ Selcuk University School of Medicine, Konya, Turkey.
²⁰ Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy.
²¹ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy.
²² Hacettepe University School of Medicine, Ankara, Turkey.
²³ Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
²⁴ Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy/Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy.
²⁵ Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy.
²⁶ UOC Neurologia-Stroke Unit, Presidio "A. Manzoni," ASST Lecco, Italy/Department of Neurology, Ospedale Santa Chiara, Trento, Italy.
²⁷ Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, "Tor Vergata" University, Rome, Italy.
²⁸ SC Neurologia 1, Ospedale Maria Vittoria, Torino, Italy.
²⁹ Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy.
³⁰ Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
³¹ Department "GF Ingrassia" Section of Neurosciences, University of Catania, Catania, Italy.
³² Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy.
³³ Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy.
³⁴ UOC Neurologia, ASUR Marche, Fermo, Italy.
³⁵ IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy/Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.
³⁶ Neurology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Trieste, Italy.
³⁷ IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy.
³⁸ Ondokuz Mayis University School of Medicine, Samsun, Turkey.
³⁹ Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey.
⁴⁰ UOC di Neurologia, Ospedale Morgagni-Pierantoni, Forlì, Italy.
⁴¹ Multiple Sclerosis Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy.
⁴² Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
⁴³ Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy.
⁴⁴ Department of Neuroscience, Città della Salute e della Scienza University Hospital, Turin, Italy.
⁴⁵ Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy.
⁴⁶ Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.

PMID: 37232279
PMCID: PMC10225808
DOI: 10.1177/13524585231176174

Abstract

Background: In the general population, maternal SARS-CoV-2 infection during pregnancy is associated with worse maternal outcomes; however, only one study so far has evaluated COVID-19 clinical outcomes in pregnant and postpartum women with multiple sclerosis, showing no higher risk for poor COVID-19 outcomes in these patients.

Objective: In this multicenter study, we aimed to evaluate COVID-19 clinical outcomes in pregnant patients with multiple sclerosis.

Methods: We recruited 85 pregnant patients with multiple sclerosis who contracted COVID-19 after conception and were prospectively followed-up in Italian and Turkish Centers, in the period 2020-2022. A control group of 1354 women was extracted from the database of the Multiple Sclerosis and COVID-19 (MuSC-19). Univariate and subsequent logistic regression models were fitted to search for risk factors associated with severe COVID-19 course (at least one outcome among hospitalization, intensive care unit [ICU] admission and death).

Results: In the multivariable analysis, independent predictors of severe COVID-19 were age, body mass index ⩾ 30, treatment with anti-CD20 and recent use of methylprednisolone. Vaccination before infection was a protective factor. Vaccination before infection was a protective factor. Pregnancy was not a risk nor a protective factor for severe COVID-19 course.

Conclusion: Our data show no significant increase of severe COVID-19 outcomes in patients with multiple sclerosis who contracted the infection during pregnancy.

Keywords: COVID-19; COVID-19 outcomes; Multiple sclerosis; SARS-CoV-2 infection; pregnancy; risk factors.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: S. Sen has received honoraria or consultancy fees for participating to advisory boards, giving educational lectures and/or travel and registration coverage for attending scientific congresses or symposia from F. Hoffmann-La Roche Ltd, Sanofi-Genzyme, Merck-Serono, Novartis, Teva, Biogen Idec/Gen Pharma. R. Karabudak has received honoraria for giving educational lectures, consultancy fees for participating advisory boards, and travel grants for attending scientific congresses or symposia from Roche, Sanofi-Genzyme, Merck-Serono, Novartis, Teva, Biogen Idec/Gen Pharma of Turkey, Abdi İbrahim İlac, Deva and ARIS. A. Siva has received honoraria or consultancy fees for participating to advisory boards, giving educational lectures and/or travel and registration coverage for attending scientific congresses or symposia from F. Hoffmann-La Roche Ltd, Sanofi-Genzyme, Merck-Serono, Novartis, Teva, Biogen Idec/Gen Pharma of Turkey and Abdi İbrahim İlac. E. Portaccio received compensation for travel grants, participation in advisory board and/or speaking activities from Biogen, Merck Serono, Sanofi, Teva, and Novartis; serves on the editorial board of Frontiers in Neurology and Brain Sciences. M.P. Amato served on scientific advisory boards for and has received speaker honoraria and research support from Biogen Idec, Merck Serono, Bayer Schering Pharma, and Sanofi Aventis, and serves on the editorial board of Multiple Sclerosis Journal and BMC Neurology. M.P. Sormani received consulting fees from Roche, Biogen, Merck, Novartis, Sanofi, Celgene, Immunic, Geneuro, GSK, Medday; received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Roche, Biogen Merck, Novartis, Sanofi, Celgene; participated on a Data Safety Monitoring Board or Advisory Board for Roche, Sanofi, Novartis, Merck. P. Confalonieri has received honoraria for speaking or consultation fees from Novartis and Biogen, has received funding for travel to attend scientific events or speaker honoraria from Merck Serono, Biogen Idec, Teva, Mylan and Roche. He has also received institutional research support from Merk-Serono, Novartis and Roche. He is also principal investigator in clinical trials for Biogen, Merck Serono, Roche. I. Schiavetti received consulting fees from Hippocrates Research, NovaNeuro, Sakura Italia, ADL Farmaceutici, Associazione Commissione Difesa Vista Onlus. M. Inglese received research grants from NIH, DOD, NMSS, FISM, and Teva Neuroscience; received fees for participating in advisory boards from Roche, Biogen, Merck and Genzyme. M. Radaelli received speaker honoraria from Biogen Idec, Sanofi-Genzyme, Novartis and Merck Serono and funding for travel to scientific meetings from Biogen Idec, Sanofi-Genzyme, Novartis, Merck Serono, Teva and Roche. N. De Rossi received speaker honoraria from Biogen Idec, Genzyme, Novartis, Sanofi-Aventis; received funding for participation in advisory board to Novartis, Biogen and Genzyme-Sanofi and for travel to scientific meetings from Biogen Idec, Teva, Sanofi-Genzyme, Roche, Almirall and Novartis. P. Immovilli reports personal fees from Roche, personal fees from Biogen, personal fees from Merck, outside the submitted work. M. Capobianco reports personal fees and non-financial support from Biogen, personal fees and non-financial support from Merck Serono, personal fees and non-financial support from Roche, personal fees and non-financial support from Novartis, personal fees and non-financial support from Sanofi, personal fees from Almirall, outside the submitted work. M. Trojano reports grants and personal fees from Biogen, grants and personal fees from Novartis, grants and personal fees from Roche, grants and personal fees from Merck, personal fees from Sanofi, personal fees from TEVA, from null, outside the submitted work. G. Comi reports personal fees from Novartis, Teva Pharmaceutical Industries Ltd, Teva Italia Srl, Sanofi Genzyme, Genzyme Corporation, Genzyme Europe, Merck KGgA, Merck Serono SpA, Celgene Group, Biogen Idec, Biogen Italia Srl, F. Hoffman-La Roche, Roche SpA, Almirall SpA, Forward Pharma, Medday, Excemed, outside the submitted work. F. Patti reports grants from Biogen, grants from Merck, grants from FISM, grants from Onlus association, grants from University of Catania, personal fees from Almirall, personal fees from Bayer, personal fees from Biogen, personal fees from Merck, personal fees from Roche, personal fees from Sanofi, personal fees from TEVA, outside the submitted work. M. Salvetti reports grants and personal fees from Biogen, grants and personal fees from Merck, grants and personal fees from Novartis, grants and personal fees from Roche, grants and personal fees from Sanofi, grants and personal fees from Teva, grants from Italian Multiple Sclerosis Foundation, grants from Sapienza University of Rome, outside the submitted work. C. Cordioli received grants or contracts from Roche, Novartis, Merck Serono, Biogen, Celgene; received consulting fees from Biogen. R. Bergamaschi has served on scientific advisory boards for Biogen, Merck-Serono, Novartis, Sanofi-Genzyme; received research support from Almirall, Bayer, Biogen, Merck-Serono, Novartis, Sanofi-Genzyme; received support for travel and congress from Biogen, Roche, Merck-Serono, Sanofi-Genzyme, Teva; received honoraria for speaking engagements from Biogen, Merck-Serono, Novartis, Sanofi-Genzyme. M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Associate Editor of Radiology and Associate Editor of Neurological Sciences; received compensation for consulting services and/or speaking activities from Alexion, Almirall, Bayer, Biogen, Celgene, Eli Lilly, Genzyme, Merck-Serono, Novartis, Roche, Sanofi, Takeda and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla and ARiSLA (Fondazione Italiana di Ricerca per la SLA). He received speaker honoraria from the following companies: Biogen, Merck, Novartis, Roche, Sanofi-Genzyme and TEVA. E. Cocco reports grants, personal fees, and non-financial support from Biogen and Merck; personal fees and non-financial support from Novartis; grants from Roche; and personal fees from Genzyme, outside the submitted work. L. Moiola received compensation for consulting services, travel grants, and/or speaking activities from Biogen, Serono, Sanofi, Teva, Roche, and Novartis. P. Perini has received speaker honoraria and consulting fees from Biogen, Merck Serono, Novartis, Roche, Sanofi Genzyme, and TEVA.

The remaining authors have nothing to report.

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Sars-CoV2 infection in pregnant women with multiple sclerosis

Affiliations

Sars-CoV2 infection in pregnant women with multiple sclerosis

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous