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CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(03): 165-171
DOI: 10.1055/s-0040-1722157
Original Article
High Risk Pregnancy

Disease Progression and Obstetric Outcomes of Women with Multiple Sclerosis at a Reference Center in Northeastern Brazil

Progressão da doença e desfechos obstétricos em mulheres portadoras de esclerose múltipla em um centro de referência no Nordeste brasileiro
Gabrielle Maria Carvalho de Barros 
1   Department of Obstetrics and Gynecology, Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, PB, Brazil
,
Bianca Etelvina Santos de Oliveira 
2   Centro de Referência em Esclerose Múltipla da Paraíba, Fundação Centro Integrado de Apoio ao Portador de Deficiência, João Pessoa, PB, Brazil
,
Gabriela Januário Oliveira 
1   Department of Obstetrics and Gynecology, Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, PB, Brazil
,
Rômulo Kunrath Pinto Silva 
1   Department of Obstetrics and Gynecology, Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, PB, Brazil
,
Thiago Nóbrega Cardoso 
3   Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Sabina Bastos Maia 
1   Department of Obstetrics and Gynecology, Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, PB, Brazil
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Abstract

Objective To describe the obstetric outcomes of patients with multiple sclerosis (MS) and the impact of pregnancy and the postpartum period on the progression of the disease.

Methods A case series study performed between December 2019 and February 2020, reporting pregnancies occurred between 1996 and 2019. The subjects included were women with MS undergoing follow-up at an MS referral center in Northeastern Brazil, and who had at least one pregnancy after the onset of MS symptoms, or who had their first relapse in the first year after delivery.

Results In total, 26 women and 38 pregnancies were analyzed – 32 of them resulted in delivery, and the remaining 6, in miscarriages. There was a significant increase in the prevalence of relapse during the postpartum period when compared with the gestational period. In 16 (42.1%) of the pregnancies, there was exposure to disease-modifying therapies (DMTs) – 14 (36.8%), to interferon β, and 2 (5.3%), to fingolimod. Higher rates of abortion, prematurity and low birth weight were reported in the group was exposed to DMT when compared with the one who was not.

Conclusion In the sample of the present study, there was a significant increase in the rate of MS relapse during the postpartum period when compared with the gestational period. Additionally, it seems that exposure to DMTs during pregnancy may affect the obstetric outcomes of the patients.

Resumo

Objetivo Descrever os desfechos obstétricos de pacientes com esclerose múltipla (EM) e o impacto da gravidez e do período pós-parto na progressão da doença.

Métodos Uma série de casos realizada entre dezembro de 2019 e fevereiro de 2020, que retrata gestações ocorridas entre 1996 e 2019. As pacientes incluídas neste estudo foram mulheres com EM, que realizam acompanhamento em um centro de referência em EM no Nordeste do Brasil, e que tiveram ao menos uma gestação após o início dos sintomas da EM, ou tiveram o primeiro surto da doença no ano posterior ao parto.

Resultados No total, 26 mulheres e 38 gestações foram avaliadas – dentre as quais, 32 resultaram em partos, e 6, em abortamentos. Houve um aumento significativo na prevalência de surtos durante o pós-parto quando comparado com o período gestacional. Em 16 (42,1%) das gravidezes, houve exposição a terapias modificadoras da doença (TMDs) – 14 (36,8%) a β-interferona, e 2 (5,3%) a fingolimode. As taxas de abortamento, prematuridade e baixo peso ao nascer foram mais elevadas no grupo exposto às TMDs quando comparado com o não exposto.

Conclusão Na amostra deste estudo, houve um aumento significativo na taxa de surtos da EM durante o período pós-parto quando comparado com o período gestacional. Além disso, a exposição às TMDs durante a gestação pode afetar os desfechos obstétricos das pacientes.

Keywords

multiple sclerosis - pregnancy - postpartum period - infant - newborn - abortion

Palavras-chave

esclerose múltipla - gravidez - período pós-parto - bebê - recém-nascido - aborto

Contributors

All authors contributed to the concept and design of the present study; analysis and interpretation of data; draft or revision of the manuscript; and they have approved the manuscript as submitted. All authors are responsible for the reported research.




Publication History

Received: 09 July 2020

Accepted: 06 October 2020

Article published online:
15 April 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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