Maternal and fetal outcomes in an Italian multicentric cohort of women with multiple sclerosis exposed to dimethyl fumarate during pregnancy

被引：0

作者：

Landi, Doriana ^{[1
]}

Bartolomeo, Silvia ^{[1
]}

Bovis, Francesca ^{[2
]}

Amato, Maria Pia ^{[3
]}

Bonavita, Simona ^{[4
,5
]}

Borriello, Giovanna ^{[6
,7
]}

Buccafusca, Maria ^{[8
]}

Bucello, Sebastiano ^{[9
]}

Cavalla, Paola ^{[10
]}

Cellerino, Maria ^{[11
]}

Centonze, Diego ^{[12
,13
]}

Cocco, Eleonora ^{[14
]}

Conte, Antonella ^{[15
,16
]}

Cortese, Antonio ^{[17
]}

D'Amico, Emanuele ^{[18
]}

Di Filippo, Massimiliano ^{[19
]}

Docimo, Renato ^{[5
,20
]}

Fantozzi, Roberta ^{[13
]}

Ferraro, Elisabetta ^{[5
,17
]}

Filippi, Massimo ^{[21
]}

Foschi, Matteo ^{[22
,23
]}

Gallo, Antonio ^{[24
]}

Granella, Franco ^{[25
]}

Ianniello, Antonio ^{[16
]}

Lanzillo, Roberta ^{[26
]}

Lorefice, Lorena ^{[27
]}

Lucchini, Matteo ^{[28
,29
]}

Lus, Giacomo ^{[30
,31
]}

Mataluni, Giorgia ^{[1
]}

Mirabella, Massimiliano ^{[28
,29
]}

Moiola, Lucia ^{[21
]}

Napoli, Francesca ^{[1
]}

Nicoletti, Carolina Gabri ^{[1
]}

Patti, Francesco ^{[32
]}

Ragonese, Paolo ^{[33
]}

Realmuto, Sabrina ^{[34
,35
]}

Schiro, Giuseppe ^{[33
]}

Signoriello, Elisabetta

Sinisi, Leonardo ^{[36
]}

Stromillo, Maria Laura ^{[37
]}

Tomassini, Valentina ^{[38
,39
]}

Vecchio, Domizia ^{[40
]}

Sormani, Maria Pia ^{[2
,41
]}

Marfia, Girolama Alessandra ^{[1
]}

机构：

[1] Tor Vergata Univ, Fdn PTV Policlin Tor Vergata, Dept Syst Med, Multiple Sclerosis Clin & Res Unit, Rome, Italy

[2] Univ Genoa, Dept Hlth Sci, Biostat Unit, Genoa, Italy

[3] Univ Florence, Dept NEUROFARBA, Florence, Italy

[4] IRCCS Fdn Don Carlo Gnocchi, Florence, Italy

[5] Univ Campania Luigi Vanvitelli, Dept Adv Med & Surg Sci, Naples, Italy

[6] San Pietro Fatebenefratelli Hosp, MS Ctr, Neurol Unit, Rome, Italy

[7] Univ Naples Federico II, Dept Publ Hlth, Naples, Italy

[8] G Martino Univ Hosp, Multiple Sclerosis Ctr, Neurol & Neuromuscular Unit, Messina, Italy

[9] E Muscatello Hosp, Multiple Sclerosis Ctr, ASP8, Augusta, Italy

[10] City Hlth & Sci Univ Hosp Turin, Dept Neurosci, Turin, Italy

[11] Univ Genoa, Dept Neurol Rehabil Ophthalmol, Clin Neurolog, Genoa, Italy

[12] Tor Vergata Univ, Dept Syst Med, Italy Synapt Immunopathol Lab, Rome, Italy

[13] Unit Neurol, IRCCS Neuromed, Pozzilli, Italy

[14] Univ Cagliari, Binaghi Hosp, ATS Sardegna, Multiple Sclerosis Ctr,Dept Med Sci & Publ Hlth, Cagliari, Italy

[15] IRCCS Neuromed, Pozzilli, Italy

[16] Sapienza Univ, Dept Human Neurosci, Rome, Italy

[17] S Filippo Neri Hosp, Multiple Sclerosis Ctr, Rome, Italy

[18] Univ Foggia, Dept Med & Surg Sci, Foggia, Italy

[19] Univ Perugia, Dept Med & Surg, Sect Neurol, Perugia, Italy

[20] San Giuseppe Moscati Hosp, ASL Caserta, Multiple Sclerosis Ctr, Aversa, Italy

[21] Univ Vita Salute San Raffaele, IRCCS San Raffaele Inst, Multiple Sclerosis Ctr, Neurol Unit, Milan, Italy

[22] S Maria Croci Hosp Ravenna, Multiple Sclerosis Ctr, Dept Neurosci, Neurol Unit, Ravenna, Italy

[23] Univ Aquila, Dept Biotechnol & Appl Clin Sci, Laquila, Italy

[24] Univ Campania Luigi Vanvitelli, Multiple Sclerosis Ctr, Dept Adv Med & Surg Sci, Naples, Italy

[25] Univ Parma, Dept Med & Surg, Parma, Italy

[26] Univ Federico II, Dept Neurosci & Reprod & Odontostomatol Sci, Multiple Sclerosis Clin Care, Naples, Italy

[27] ASL Cagliari, Binaghi Hosp, Multiple Sclerosis Ctr, Dept Med Sci & Publ Hlth, Cagliari, Italy

[28] Fdn Policlin Univ Agostino Gemelli IRCCS, Multiple Sclerosis Ctr, Rome, Italy

[29] Univ Cattolica Sacro Cuore, Ctr Ric Sclerosi Multipla CERSM, Dept Neurosci, Rome, Italy

[30] Univ Campania Luigi Vanvitelli, Multiple Sclerosis Ctr, Neurol Clin 2, Naples, Italy

[31] Univ Campania Luigi Vanvitelli, Dept Med & Surg Sci, Naples, Italy

[32] Univ Catania, MS Ctr, Dept GF Ingrassia, Catania, Italy

[33] Univ Palermo, Dept Biomed Neurosci & Adv Diagnost, Palermo, Italy

[34] AOOR Villa Sofia Cervello, Multiple Sclerosis Ctr, Neurol Unit, Palermo, Italy

[35] AOOR Villa Sofia Cervello, Stroke Unit, Palermo, Italy

[36] San Paolo Hosp ASL Napoli 1 Ctr, Neurol Unit & MS Ctr, Dept Neurol, Naples, Italy

[37] Univ Siena, Dept Med Surg & Neurosci, Siena, Italy

[38] Univ G dAnnunzio, Inst Adv Biomed Technol ITAB, Dept Neurosci, Imaging & Clin Sci, Chieti, Pescara, Italy

[39] SS Annunziata Univ Hosp, MS Ctr, Clin Neurol, Chieti, Italy

[40] Univ Eastern Piedmont Avogadro, Multiple Sclerosis Ctr, Dept Translat Med, Neurol Unit, Novara, Italy

[41] IRCCS Osped Policlin San Martino, Genoa, Italy

来源：

MULTIPLE SCLEROSIS JOURNAL | 2024年 / 30卷 / 11-12期

关键词：

Multiple sclerosis; dimethyl fumarate; pregnancy; PREDICTORS;

D O I：

10.1177/13524585241274600

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Evidence on the impact of dimethyl fumarate (DMF) during pregnancy in women with multiple sclerosis (MS) is limited.Objectives: To investigate disease activity and pregnancy outcomes in a retrospective cohort of women exposed to DMF in early pregnancy.Methods: Women discontinuing DMF after pregnancy confirmation were identified from 29 Italian MS Centers. Disease activity 12 months before conception, during pregnancy, and 12 months postpartum were recorded, exploring reactivation predictors. Pregnancy and fetal outcomes were assessed.Results: The study analyzed 137 pregnancies (12 pregnancy losses, 125 live births) from 137 women (mean age 32.9 +/- 4.7 years), discontinuing DMF within a median (interquartile range (IQR)) interval of 4.9 (3.7-5.7) weeks from conception. In live birth pregnancies, annualized relapse rate (ARR) significantly decreased during pregnancy (ARR = 0.07, 95% confidence interval (CI): 0.03-0.14, p = 0.021) compared to pre-conception (ARR = 0.21 (95% CI: 0.14-0.30)) and increased postpartum ((ARR = 0.22 (95% CI: 0.15-0.32), p = 0.006). Median time to first relapse (TTFR) was 3.16 (IQR: 1:87-5.42) months. Higher pre-conception relapse number (hazard ratio (HR) = 2.33, 95% CI: 1.08-5.02) and Expanded Disability Status Scale (EDSS; HR = 1.81, 95% CI: 1.17-2.74) were associated with shorter TTFR, while treatment resumption with longer TTFR (HR = 0.29, 95% CI: 0.11-0.74). Fetal outcomes were unaffected by DMF exposure.Conclusion: DMF discontinuation does not increase relapse risk during pregnancy. Early therapy restart prevents postpartum relapses. Early DMF exposure shows no adverse fetal outcomes.

引用

页码：1503 / 1513

页数：11

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