Abstract
Objectives The aim of this study was to asses pregnancy outcomes and disease activity after apheresis in women with multiple sclerosis (MS).
Methods Women who relapsed during pregnancy and received apheresis, documented in the German Multiple Sclerosis and Pregnancy Registry (DMSKW) are presented. Pregnancy outcomes and disease course were captured with a standardized questionnaire in regular telephone interviews during pregnancy and post-partum. Relapse, treatment data and EDSS-values were verified by treating physicians.
Results In 28 pregnancies 15(53.6%) women received immunadsorption, 8(28.6%) received therapeutic plasma exchange and 5(18%) received both on separate occassions due to severe relapses, with a median(range) EDSS of 4(1.5–9.5) during relapse. The median (range) number of apheresis cycles was 5(2–8). Most women (92.86%) received corticosteroids prior to apheresis with a mean(SD) of 1950mg(375mg). 28 live-births with 2(7.4%) congenital malformations were reported, transposition of the great arteries and hip dysplasia. 3(10.7%) SGA births were reported and 6(21.4%) babies were born prematurely. The mean(SD) birthweight was 2688g(792.2g) and excluding pre-term births, 3006g(514.1g).
Conclusion Women with severe relapses receiving a combination of corticosteroids and apheresis during pregnancy have a higher risk for preterm birth and reduced birthweight. Our data add useful information on pregnancy outcomes after treatment with apheresis during pregnancy, however is limited by the small sample size. Also, concurrent corticosteroid exposure is a possible confouding factor, which will be investigated in further analysis. Women with highly active MS should be counselled and plan their pregnancy beforehand.
