Peripartum neuraxial analgesia may not be associated with an increased risk for multiple sclerosis (MS) relapse, regardless of disease activity during pregnancy, according to a study published in the Multiple Sclerosis Journal.
Because of concerns that the use of neuraxial analgesia in women with MS giving birth may have toxic effects on demyelinated fibers and may be associated with subsequent MS relapse, clinicians, including neurologists, anesthesiologists, and obstetricians, may be hesitant to use this modality.
In this retrospective analysis, data from 2 prospective trials were examined: the Pregnancy in Multiple Sclerosis (PRIMS) study conducted between 1992 and 1995 and the Prevention of Postpartum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS; Clinicaltrials.gov identifier NCT00127075) study, conducted between 2005 and 2012. In both trials, patients were followed during pregnancy and for ≥3 months postpartum. Disease activity and relapse rate during pregnancy and for 3 months following birth were examined.
Data from 389 women (median age at MS onset, 24.1 years; median age at pregnancy onset, 31.4 years; median MS duration at onset of pregnancy, 5.7 years) were analyzed (from the PRIMS study, n=215; from the POPARTMUS, n=174). There were 156 women (40.1%) who received neuraxial analgesia (18.6% in the PRIMS study; 66.7% in the POPARTMUS study). A total of 93 women (23.9%) experienced relapse during pregnancy and another 97 women (24.9%) had relapse within 3 months of giving birth. Women in the POPARTMUS study had lower postpartum relapse rates compared with women in the PRIMS study (19.5% vs 29.3%, respectively; P =.04).
After multivariable adjustment, no association was established between use of neuraxial analgesia and the occurrence of MS relapse in the 3 months following birth (odds ratio, 1.08; 95% CI, 0.62-1.89; P =.78). The only factor independently linked with postpartum relapse was the number of MS relapses occurring during the course of pregnancy (odds ratio, 1.83; 95% CI, 1.09-3.09; P =.02). Women with vs without any relapses during pregnancy had a greater rate of ≥1 postpartum relapse in the 3 months after giving birth (35.5% vs 21.6%, respectively; P =.007).
Study limitations include the retrospective design, lack of information on the specific analgesic procedure, use of 2 different studies conducted >10 years apart, disparity between studies regarding rates of neuraxial analgesia, and possible underpowering.
“Our study provides additional arguments toward the harmlessness of neuraxial analgesia in parturient women with MS, whatever their MS activity during pregnancy,” noted the authors. They recommended that future research involve more prospective trials.
Lavie C, Rollot F, Durand-Dubief F, et al. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS. Mult Scler. 2019;25(4):591-600.