Analysis Finds Rising Pregnancy Rates Among Women With Multiple Sclerosis

A retrospective study by Houtchens et al on annual pregnancy rates from 2006 to 2014 reveals that US women with multiple sclerosis (MS) had increased pregnancy rates as compared to women without MS.

MS is a progressive neurological disease that has been more frequently diagnosed in women of childbearing age than in any other subgroup. Earlier, there were concerns about the impact of the disease on the health of the patient’s child or that patients may suffer from neurological symptoms during or after pregnancy, either due to the pregnancy itself or from the discontinuation of disease-modifying drugs. Previous studies, however, showed that pregnancy complications were not more likely in women with MS than healthy, childbearing women.

The increased knowledge that clinicians have in handling complex cases of MS have sparked some interest in evaluating pregnancy rates for women with MS in comparison with healthy women. Data collected from the IQVIA Real-World Data Adjudicated Claims-US database was analyzed by Houtchens et al to determine and compare pregnancy rates and pregnancy-related outcomes between women with and without MS.

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Women aged 18 to 64 were enrolled in this study and assigned to cohorts based on whether they had a diagnosis of MS. In 2006, 8.83% of women without MS were pregnant, compared with 7.91% of women with MS. Eight years later, in 2014, 7.75% of women without MS, but had increased to 9.47% in women with MS. Among the women who had a live birth, median and mean ages were also higher for women with MS than those without.

After analyzing the data for pregnancy complications, investigators observed a significantly higher proportion of women with MS and a claim for premature labor (P = .005), infection during pregnancy (P = .016), maternal cardiovascular disease (P = .028), anemia or acquired coagulation disorder (P = .007), neurologic complications in pregnancy (P = .005), and sexually transmitted diseases in pregnancy (P = .045). There was also a significantly higher proportion of women with MS who had a claim for acquired fetus damage (P = .002) and congenital fetal malformations (P = .004). Women without MS, however, had a higher rate of postterm pregnancy (P <.001) than women with MS.

As clinicians become more comfortable in managing women with MS and allowing more of them to experience motherhood, it comes without surprise that the pregnancy rates would also increase. The increased rates of the complications observed in women with MS was interesting but could have been associated from the comprehensiveness of the ICD-9 CM code. Once the nonspecific pregnancy and labor and delivery outcomes were removed, the differences in absolute rates of complications were small and not significantly different. More information on clinician care in women with MS will be needed to decide whether these complications can be prevented.

Reference

Houtchens MK, Edwards NC, Schenider G, Stern K, Phillips AL. Pregnancy rates and outcomes in women with and without MS in the United States [published online September 28, 2018]. Neurology. doi: 10.1212/WNL.0000000000006384.