Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study
1 Department of Neurology, University of Florence, Viale Morgagni 85, 50134, Florence, Italy
2 Multiple Sclerosis Center, S Antonio Abate Hospital, Gallarate, Italy
3 Multiple Sclerosis Center, S Andrea Hospital, La Sapienza University, Rome, Italy
4 Department of Neurology, University of Bari, Bari, Italy
5 Multiple Sclerosis Center, Department of Neurology, University of Cagliari, Cagliari, Italy
6 Multiple Sclerosis Center, University of Catania, Catania, Italy
7 MS Center, C Besta National Neurological Institute, Milan, Italy
8 Department of Neurology, University of Genova, Genova, Italy
9 Department of Neurology, ASL3 Genovese, Genova, Italy
10 Department of Neurosciences, University of L’Aquila, L’Aquila, Italy
11 Department of Neuroscience, University of Ferrara, Ferrara, Italy
12 Department of Neurosciences and Imaging, University G. d'Annunzio Chieti, Centro Sclerosi Multipla, Chieti, Italy
13 Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
14 Don Carlo Gnocchi Foundation, ONLUS, Florence, Italy
BMC Neurology 2012, 12:165 doi:10.1186/1471-2377-12-165Published: 31 December 2012
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.
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.
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).
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.