ECTRIMS eLearning

Disease-modifying therapies, fertility and post-partum multiple sclerosis course: interim data from PREG-MS cohort
Author(s): ,
M.C. Manieri
Affiliations:
Ann Romney Center for Neurologic Diseases, Brigham and Women`s Hospital, Havard Medical School, Boston, MA, United States
,
T.D. Mahlanza
Affiliations:
Ann Romney Center for Neurologic Diseases, Brigham and Women`s Hospital, Havard Medical School, Boston, MA, United States
,
M. Houtchens
Affiliations:
Ann Romney Center for Neurologic Diseases, Brigham and Women`s Hospital, Havard Medical School, Boston, MA, United States
On behalf of the PREG-MS Study Group
Affiliations:
Ann Romney Center for Neurologic Diseases, Brigham and Women`s Hospital, Havard Medical School, Boston, MA, United States
ECTRIMS Learn. Manieri M. 10/11/18; 228533; P689
Maria Claudia Manieri
Maria Claudia Manieri
Contributions
Abstract

Abstract: P689

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - MS and gender

Background: Up to 33% of women with Multiple Sclerosis (MS) become pregnant after disease onset. Relationship between pre-partum disease modifying therapies (DMTs) and post-partum MS course is important for women desiring pregnancy. Several studies suggest that injectable versus high-efficacy DMTs have a different impact on pregnancy and post-partum MS course.
PREG-MS is the New England MS Pregnancy Prospective Cohort Study in the United States. It follows women with MS in active conception attempts, and from any stage of conception to three years postpartum.
Methods: Participants' MS course, DMTs, fertility and pregnancy course and outcome, and their children's health and development is collected through structured phone interviews, and validated with medical records. Research Electronic Data Capture is used for data storage and STATA statistical software is used for analysis.
Results: To date, 100 referrals were made to PREG-MS, of which 73 are actively participating, 21 are awaiting consent, and 6 have withdrawn or declined participation.
18 women (25%) had infertility diagnosis. 8 women (11%) had a relapse while actively trying to conceive, including one relapse preceded by an unsuccessful in vitro fertilization cycle. Longevity of conception attempts (4.18 ± 0.84 months) is predicted by infertility diagnosis (p=0.0001) and having a relapse while trying to conceive (p< 0.0001).
16 subjects had early pregnancy (4.31 ± 0.66 weeks) DMT exposures and one subject was exposed to glatiramer acetate (GA) in late pregnancy. One ventricular septal defect and intrauterine growth restriction were seen in fingolimod and GA exposure respectively.
Higher postpartum EDSS (1.025 ± 0.33) was seen in women with longer time to conception (p=0.0077) and infertility (p=0.0393). 25 % of women on injectable DMTs pre-partum (n=20) had postpartum relapse and breastfed for 2.34 ± 0.65 months before re-starting therapy. 42% of women on high-efficacy DMTs pre-partum (n=12) had postpartum relapse, breastfed for 5.63 ± 1.36 months and stopped due to non-MS related factors. A trend for fewer post-partum relapses, shorter breastfeeding time and earlier restart of the DMT post-partum was observed in women on injectable DMT pre-partum.
Conclusion: This prospective MS pregnancy dataset suggests that infertility, extended time to conception and pregnancy exposure to DMTs are common. Post-partum disease reactivation is often seen with pre-pregnancy discontinuation of high efficacy DMTs.
Disclosure: Maria Claudia Manieri: nothing to disclose.
Tatenda D Mahlanza: nothing to disclose.
Maria Houtchens: Unrestricted research grants from Sanofi Genzyme, Serono and Biogen, and consulting income from Sanofi Genzyme, Biogen, Serono, Novartis, Genentech, and Teva. No conflict with this abstract.

Abstract: P689

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - MS and gender

Background: Up to 33% of women with Multiple Sclerosis (MS) become pregnant after disease onset. Relationship between pre-partum disease modifying therapies (DMTs) and post-partum MS course is important for women desiring pregnancy. Several studies suggest that injectable versus high-efficacy DMTs have a different impact on pregnancy and post-partum MS course.
PREG-MS is the New England MS Pregnancy Prospective Cohort Study in the United States. It follows women with MS in active conception attempts, and from any stage of conception to three years postpartum.
Methods: Participants' MS course, DMTs, fertility and pregnancy course and outcome, and their children's health and development is collected through structured phone interviews, and validated with medical records. Research Electronic Data Capture is used for data storage and STATA statistical software is used for analysis.
Results: To date, 100 referrals were made to PREG-MS, of which 73 are actively participating, 21 are awaiting consent, and 6 have withdrawn or declined participation.
18 women (25%) had infertility diagnosis. 8 women (11%) had a relapse while actively trying to conceive, including one relapse preceded by an unsuccessful in vitro fertilization cycle. Longevity of conception attempts (4.18 ± 0.84 months) is predicted by infertility diagnosis (p=0.0001) and having a relapse while trying to conceive (p< 0.0001).
16 subjects had early pregnancy (4.31 ± 0.66 weeks) DMT exposures and one subject was exposed to glatiramer acetate (GA) in late pregnancy. One ventricular septal defect and intrauterine growth restriction were seen in fingolimod and GA exposure respectively.
Higher postpartum EDSS (1.025 ± 0.33) was seen in women with longer time to conception (p=0.0077) and infertility (p=0.0393). 25 % of women on injectable DMTs pre-partum (n=20) had postpartum relapse and breastfed for 2.34 ± 0.65 months before re-starting therapy. 42% of women on high-efficacy DMTs pre-partum (n=12) had postpartum relapse, breastfed for 5.63 ± 1.36 months and stopped due to non-MS related factors. A trend for fewer post-partum relapses, shorter breastfeeding time and earlier restart of the DMT post-partum was observed in women on injectable DMT pre-partum.
Conclusion: This prospective MS pregnancy dataset suggests that infertility, extended time to conception and pregnancy exposure to DMTs are common. Post-partum disease reactivation is often seen with pre-pregnancy discontinuation of high efficacy DMTs.
Disclosure: Maria Claudia Manieri: nothing to disclose.
Tatenda D Mahlanza: nothing to disclose.
Maria Houtchens: Unrestricted research grants from Sanofi Genzyme, Serono and Biogen, and consulting income from Sanofi Genzyme, Biogen, Serono, Novartis, Genentech, and Teva. No conflict with this abstract.

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