Open Access Open Badges Research article

Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study

Luisa Pastò1, Emilio Portaccio114, Angelo Ghezzi2, Bahia Hakiki114, Marta Giannini1, Lorenzo Razzolini114, Elisa Piscolla1, Laura De Giglio3, Carlo Pozzilli3, Damiano Paolicelli4, Maria Trojano4, Maria Giovanna Marrosu5, Francesco Patti6, Loredana La Mantia7, Gian Luigi Mancardi8, Claudio Solaro9, Rocco Totaro10, Maria Rosaria Tola11, Valeria Di Tommaso12, Alessandra Lugaresi12, Lucia Moiola13, Vittorio Martinelli13, Giancarlo Comi13, Maria Pia Amato1* and and for the MS Study Group of the Italian Neurological Society

Author affiliations

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

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Citation and License

BMC Neurology 2012, 12:165  doi:10.1186/1471-2377-12-165

Published: 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.

Epidural analgesia; Caesarean delivery; Multiple sclerosis; Pregnancy