Author Of 1 Presentation
P1126 - Impact of interferon-beta exposure during early pregnancy on relapse rate (ID 1074)
Abstract
Background
In disease modifying therapy (DMT)-unexposed pregnancies of multiple sclerosis (MS) patients, relapse rate decreases significantly during pregnancy, followed by an increase in the first 12 weeks postpartum, but little is known about the relapse pattern and the associated steroid use in interferon-β (IFN-β) -exposed pregnancies, which might not show the typical disease course.
Objectives
To determine disease activity during pregnancy in women with MS and IFN-β treatment 12 months prior to the last menstrual period (LMP).
Methods
Pregnancies were prospectively collected in the German MS and pregnancy registry up to 10.2018. Pregnancies with a duration of at least 22 gestational weeks and IFN-β treatment 12 months prior to conception were compared in two groups: pre-LMP group stopping IFN-β between 365 and 1 day before LMP and post-LMP group stopping IFN-β between LMP and 84 days afterwards.
Results
We identified 47 pregnancies in pre-LMP group and 165 pregnancies in post-LMP group, without differences in baseline characteristics (age, BMI, disease duration, IFN-β treatment duration, annualized relapse rate (ARR) before pregnancy) and a median postpartum follow up of 610 days (range 17 – 2,799). 35 of 212 women (16.5%) had at least one relapse during pregnancy, 14 (29.8%) in pre-LMP group and 21 (12.7%) in post-LMP group (p=0.011). 14 (6.6%) women experienced a relapse in trimester 1, 21 (9.9%) in trimester 2 and 7 (3.3%) in trimester 3. Notably, significantly more women in the pre-LMP group experienced a relapse in trimester 2 (OR= 4.68, CI[1.82;12.2], p=0.002). Corticosteroid use did not differ significantly between groups; neither in overall pregnancy (p= 0.399) nor per trimena (trimester 1: p= 0.686, trimester 2: p= 0.266, trimester 3: p= 0.124).
214 pregnancy outcomes were observed (including two twin pregnancies). Preterm births differed significantly with more preterm births in the pre-LMP group (pre-LMP: 8/17.02%; post-LMP: 10/6.06%; OR 3.12, p=0.03). Medically confirmed major malformations did not differ between groups (pre-LMP: 1/47 (2.13%); post-LMP: 7/167 (4.20%); OR: 0.433, p=0.687)). No stillbirth was observed.
Conclusions
The withdrawal of IFN-β before pregnancy is associated with a higher relapse risk, especially in trimester 2 and a higher chance of preterm birth, though not higher steroid use during pregnancy, but more data is needed. At the time of the meeting, updated results on disease activity especially relapse rates will be presented.
Presenter Of 1 Presentation
P1126 - Impact of interferon-beta exposure during early pregnancy on relapse rate (ID 1074)
Abstract
Background
In disease modifying therapy (DMT)-unexposed pregnancies of multiple sclerosis (MS) patients, relapse rate decreases significantly during pregnancy, followed by an increase in the first 12 weeks postpartum, but little is known about the relapse pattern and the associated steroid use in interferon-β (IFN-β) -exposed pregnancies, which might not show the typical disease course.
Objectives
To determine disease activity during pregnancy in women with MS and IFN-β treatment 12 months prior to the last menstrual period (LMP).
Methods
Pregnancies were prospectively collected in the German MS and pregnancy registry up to 10.2018. Pregnancies with a duration of at least 22 gestational weeks and IFN-β treatment 12 months prior to conception were compared in two groups: pre-LMP group stopping IFN-β between 365 and 1 day before LMP and post-LMP group stopping IFN-β between LMP and 84 days afterwards.
Results
We identified 47 pregnancies in pre-LMP group and 165 pregnancies in post-LMP group, without differences in baseline characteristics (age, BMI, disease duration, IFN-β treatment duration, annualized relapse rate (ARR) before pregnancy) and a median postpartum follow up of 610 days (range 17 – 2,799). 35 of 212 women (16.5%) had at least one relapse during pregnancy, 14 (29.8%) in pre-LMP group and 21 (12.7%) in post-LMP group (p=0.011). 14 (6.6%) women experienced a relapse in trimester 1, 21 (9.9%) in trimester 2 and 7 (3.3%) in trimester 3. Notably, significantly more women in the pre-LMP group experienced a relapse in trimester 2 (OR= 4.68, CI[1.82;12.2], p=0.002). Corticosteroid use did not differ significantly between groups; neither in overall pregnancy (p= 0.399) nor per trimena (trimester 1: p= 0.686, trimester 2: p= 0.266, trimester 3: p= 0.124).
214 pregnancy outcomes were observed (including two twin pregnancies). Preterm births differed significantly with more preterm births in the pre-LMP group (pre-LMP: 8/17.02%; post-LMP: 10/6.06%; OR 3.12, p=0.03). Medically confirmed major malformations did not differ between groups (pre-LMP: 1/47 (2.13%); post-LMP: 7/167 (4.20%); OR: 0.433, p=0.687)). No stillbirth was observed.
Conclusions
The withdrawal of IFN-β before pregnancy is associated with a higher relapse risk, especially in trimester 2 and a higher chance of preterm birth, though not higher steroid use during pregnancy, but more data is needed. At the time of the meeting, updated results on disease activity especially relapse rates will be presented.