Evaluation of clinical,demographic data of patients with multiple sclerosis and pelationship of pregnancy with prognosis: Single centered retrospective study

PURPOSE: Multiple Sclerosis (MS) inflammation is a chronic disease of the central nervous system, characterized by inflammation, demyelination, and axonal damage, often involving the white matter, but can also be seen in the cortex and deep gray matter. It usually starts between the ages of 20-40 and is 2-3 times more common in women. Pregnancy status is important in follow-up and treatment planning, as women of reproductive age constitute a significant portion of the patient population. In this study it is aimed to determine the MS disease activities of female patients with MS before, during and after pregnancy, whether fetal side effects / pregnancy complications occur, and the effect of MS disease on fertility. MATERIAL AND METHOD: 505 previously pregnant and 483 non pregnant female MS patients who applied to KTU Faculty of Medicine Neurology Outpatient Clinic between January 2010 and January 2021 were included to this study. The data of the patients were obtained from the MSBase registry system and a two-part questionnaire consisting of questions about their diseases and pregnancy processes, which were directed to them with permission from the patients. FINDINGS: While the mean relapse rate was 0.25 before pregnancy, the mean relapse rate in the postpartum 1-3 months was 0.42 (p=0.009). It was observed that the attack rate gradually decreased throughout pregnancy and was at its lowest level in the third trimester, but there was no statistically significant difference between the relapse rate before pregnancy and the relapse rates during pregnancy (p>0.050). The incidence of attacks in the postpartum period was found to be high in patients who had an attack in the preconceptional period (p=0.001). There was no significant difference in the use of assisted reproductive techniques, multiple pregnancy rate, pregnancy and delivery complications, term/preterm delivery rate, vi and postpartum incubator need for pre- and post-MS pregnancies (p's 0.248, 0.713, 0.317, 0.083, 0.135, 0.644, respectively). Only the curettage rate of post-MS pregnancies was found to be higher in propoetion to pre-MS pregnancies (p=0.029). The mean age of onset of CIS was calculated as 8000.86 ± 1866.68 days for those who had a pregnancy before CIS, and the mean age of onset of CIS for those who did not have a pregnancy before CIS was calculated as 11278.62 ± 3882.82 days (p= <0,001). It was determined that the time to reach EDSS-6 in women with MS who had pregnancy was longer than those who did not get pregnant (p=0,029). There was no significant difference between the time to reach SPMS from RRMS between those who had pregnancy and those who had never been pregnant (p=0,940). RESULT: In MS patients, the attack rate decreases during pregnancy and decreases to a minimum in the third month of pregnancy, and peaks again in the first 3 months postpartum. While the protective effect of pregnancy was detected in reaching EDSS-6, its effect in reaching SPMS was not detected. There was no significant difference in the use of assisted reproduction technique, multiple pregnancy rate, pregnancy and delivery complications, term/preterm delivery rate, and postpartum incubator need for pre- and post-MS pregnancies. MS is not an handicap for pregnancy, there is no increase in complications, but the disease should be under contro l and patients should be followed closely throughout pregnancy and in the peripartum period. Keywords: Multiple Sclerosis, pregnancy, relapse, prognosis