Pregnancy Outcomes in Women With Multiple Sclerosis

被引:45
作者
MacDonald, Sarah C. [1 ]
McElrath, Thomas F. [2 ,3 ]
Hernandez-Diaz, Sonia [1 ]
机构
[1] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, 677 Huntington Ave,Kresge Bldg, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Dept Obstet & Gynecol, Div Maternal Fetal Med, 75 Francis St, Boston, MA 02115 USA
[3] Harvard Med Sch, Boston, MA 02115 USA
关键词
administrative claims; multiple sclerosis; pregnancy; DELIVERY; HOSPITALIZATION; RISK; PREVALENCE; MANAGEMENT; NATIONWIDE;
D O I
10.1093/aje/kwy197
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Few studies have assessed the risk of adverse pregnancy outcomes in women with multiple sclerosis (MS). We used 2 large US administrative databases, the Truven Health MarketScan Database (2011-2015; Truven Health Analytics Inc., Ann Arbor, Michigan) and the Nationwide Inpatient Sample (2007-2011), to identify delivery cohorts. MS and pregnancy outcomes (infections, cesarean delivery, preterm delivery, poor fetal growth, preeclampsia, chorioamnionitis, postpartum hemorrhage, stillbirth, and infant malformations) were identified during pregnancy and at delivery. We calculated adjusted risk ratios according to MS status and relapse(s) in the year before delivery. Among over 5 million pregnancies, we identified 3,875 pregnancies in women with MS. Women with MS had an increased risk of infections during pregnancy (Truven Health: adjusted risk ratio (aRR) = 1.22, 95% confidence interval (CI): 1.16, 1.27) and preterm delivery (Truven Health: aRR = 1.19 (95% CI: 1.04, 1.35); Nationwide Inpatient Sample: aRR = 1.30 (95% CI: 1.16, 1.44)). The risks of other outcomes were similar for women with and without MS. In the Truven Health database, risk ratios for the pregnancy outcomes in women experiencing relapses versus those without relapses were between 0.9 and 1.4, and confidence intervals overlapped the null. Overall, women with MS had an increased risk of infections and preterm delivery; however, their risks for other adverse pregnancy outcomes were not elevated. Disease activity before delivery was not a strong predictor of outcomes.
引用
收藏
页码:57 / 66
页数:10
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