Maternal and neonatal outcomes in pregnant women with multiple sclerosis disease: A systematic review and meta-analysis

Objectives: Little is known regarding the impact of multiple sclerosis (MS) on maternal and neonatal outcomes. Consequently, this systematic review and meta -analysis aimed to study the impacts of MS on maternal and neonatal outcomes in pregnant women with a history of MS. Methods: This review was designed in line with the PRISMA guidelines. Two researchers conducted independent reviews of the literature without time restrictions until January 2023 using international databases, including PubMed, Web of Science, CINAHL Plus, Embase, Scopus, Science Direct, and Google Scholar. A random-effect meta -analysis, using the db metan command in Stata 17.2, was used to calculate the pooled measure of association. Results: The meta -analysis identified 15 studies involving 33,174,541 pregnant women (32,191 with MS and 33,142,350 as controls). The findings indicate that women with a history of MS are at an increased risk of cesarean delivery (OR =1.28, 95% Confidence Intervals [CI]: 1.14 -1.45, p -value: 0.042). Also, these women are at higher risk of neonatal outcomes, such as preterm birth (OR = 1.39, 95% CI: 1.08 -1.78, p -value: 0.02), congenital malformations (OR =1.32, 95%CI: 1.16 -1.50, p -value: 0.031), Apgar score <7 (OR =2.13, 95% CI: 1.19 -3.79, pvalue: 0.03), and small for gestational age (OR =1.27, 95% CI: 1.08 -1.51, p -value: 0.040). Conclusion: Pregnant women with MS have a greater chance of adverse pregnancy results than pregnant women without MS. Consequently, pregnant women with MS should create detailed before and after pregnancy plans, in consultation with their doctors, spouses, families, and friends, regarding the necessary care and supplements. Future studies applying a prospective cohort design that control for potential confounders are needed to further validate the findings.