TY - JOUR
T1 - Parity and disability progression in relapsing–remitting multiple sclerosis
AU - for the Israeli Multiple Sclerosis Pregnancy Study Group (IMSPSG)
AU - Achiron, Anat
AU - Ben-David, Alon
AU - Gurevich, Michael
AU - Magalashvili, David
AU - Menascu, Shay
AU - Dolev, Mark
AU - Stern, Yael
AU - Ziv-Baran, Tomer
N1 - Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/12
Y1 - 2020/12
N2 - Aim: It is unclear whether parity and increasing parity are risk factors for long-term disability progression in relapsing–remitting multiple sclerosis. Furthermore, data on the effects of immunomodulatory treatments in this context are limited. Objectives: To examine the association between parity and long-term neurological sequela among relapsing-remitting multiple sclerosis patients. Methods: A cohort study including all women with relapsing–remitting multiple sclerosis in Israel registered in Sheba Medical Center Multiple Sclerosis data registry from 1995 to 2018. The risks of progression to moderate and severe disability according to parity after disease onset were evaluated. Cox regression models using childbirth as a time-dependent covariate were used to study the association between parity and disability progression. Results: During the 26,785 person-years of follow-up a total of 2281 women were included in the study. Parity was associated with decreased risk of progression to moderate (adj.HR, 0.68; 95% CI 0.54–0.85, P = 0.001) but not to severe disability (adj.HR, 0.88; 95% CI 0.68–1.14, P = 0.36). Hazard ratios for progression to moderate and severe disability were comparable between women with one, two, and three or more births. In a subgroup analysis of women who gave birth within 5 years of disease onset, immunomodulatory treatment did not affect moderate or severe disability-free survival. Conclusion: This study suggests that childbirth after the onset of multiple sclerosis is associated with a decreased risk of progression to moderate neurological disability.
AB - Aim: It is unclear whether parity and increasing parity are risk factors for long-term disability progression in relapsing–remitting multiple sclerosis. Furthermore, data on the effects of immunomodulatory treatments in this context are limited. Objectives: To examine the association between parity and long-term neurological sequela among relapsing-remitting multiple sclerosis patients. Methods: A cohort study including all women with relapsing–remitting multiple sclerosis in Israel registered in Sheba Medical Center Multiple Sclerosis data registry from 1995 to 2018. The risks of progression to moderate and severe disability according to parity after disease onset were evaluated. Cox regression models using childbirth as a time-dependent covariate were used to study the association between parity and disability progression. Results: During the 26,785 person-years of follow-up a total of 2281 women were included in the study. Parity was associated with decreased risk of progression to moderate (adj.HR, 0.68; 95% CI 0.54–0.85, P = 0.001) but not to severe disability (adj.HR, 0.88; 95% CI 0.68–1.14, P = 0.36). Hazard ratios for progression to moderate and severe disability were comparable between women with one, two, and three or more births. In a subgroup analysis of women who gave birth within 5 years of disease onset, immunomodulatory treatment did not affect moderate or severe disability-free survival. Conclusion: This study suggests that childbirth after the onset of multiple sclerosis is associated with a decreased risk of progression to moderate neurological disability.
KW - Disability progression
KW - Immunomodulatory treatment
KW - Parity
KW - Pregnancy
KW - Relapsing–remitting multiple sclerosis
UR - http://www.scopus.com/inward/record.url?scp=85088710486&partnerID=8YFLogxK
U2 - 10.1007/s00415-020-10093-1
DO - 10.1007/s00415-020-10093-1
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C2 - 32725314
AN - SCOPUS:85088710486
SN - 0340-5354
VL - 267
SP - 3753
EP - 3762
JO - Journal of Neurology
JF - Journal of Neurology
IS - 12
ER -