Friday, 26 July 2013

Pregnancy and periatal outcomes in women

Vanya M, Nyari T, Bencsik K, Bartfai G. Pregnancy and perinatal outcomes among women with multiple sclerosis: A retrospective case-controlled study in South Hungary. J Matern Fetal Neonatal Med. 2013 Jul. [Epub ahead of print]

Objective: The aim of this study was to investigate the connections between MS and fertility, pregnancy. 
Methods: The case histories and pregnancy complications in a sample of 65 treatment-naive pregnant women with MS in the period 1998-2012 were compared with an age-matched case-controlled analysis. Comparisons were made between primigravidas
(women who is pregnant) and multigravidas (woman who is pregnant and has been pregnant twice before) subjects. 
Results: Our results revealed a higher rate of miscarriage (18.46 %) in the first trimester in women with MS, and intrauterine death (7.69 %) in the third trimester, as compared with women without MS (p<0.001 and p=0.035). 
Conclusions: These findings suggest that, the risk of miscarriages and intrauterine death may be disease-related not drug-related feature. Further studies are needed to determine to possible associated factors of miscarriages.

Lets put this experience from Hungary in some perspective.

About one in seven recognised pregnancies end in miscarriage, while the incidence of spontaneous (unrecognised) miscarriage is estimated to be 50% of all pregnancies.

• However, even if we restrict the figures to recognised pregnancies, the miscarriage rate is difficult to determine because many remain unreported. 

• One in four women who get pregnant will experience a miscarriage. This figure drops to one in five when only taking women who have had a positive pregnancy test into consideration 

according to the Cleveland Clinic

Using data from a Medical Birth Registry in Norway, Dahl and colleagues found that mothers with MS had a higher proportion of
small-for-gestational age babies. They also had a higher rate of induction of labor and operative interventions during delivery.

Another study of mothers who had become pregnant while on interferon therapy showed an increased rate of miscarriages
and stillbirths compared with controls. This study also found low birth weight compared with controls.

In another study from Seattle, mothers with MS were twice as likely to need to be rehospitalized compared with controls; however, in this study, there was no increase in small-for-gestational age infants, preterm infants, or infants with fetal (that is Foetal in British Ingrish) malformations. Differences among such studies may reflect different populations, obstetrical practices, and differences in the MS disease course. In general, these differences were not major and did not appear to affect the long-term health of the baby.

There are lots of posts on the blog on pregnancy do a search
Lu E, Wang BW, Guimond C, Synnes A, Sadovnick D, Tremlett H. Disease-modifying drugs for multiple sclerosis in pregnancy: a systematic review. Neurology. 2012 11;79(11):1130-5. doi:

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