Intravenous immunoglobulin treatment in the prevention of childbirth-associated acute exacerbations in multiple sclerosis: A pilot study

Acute exacerbations frequently occur after childbirth in patients with relapsing-remitting multiple sclerosis (MS). The present pilot study was initiated in an attempt to reduce the number of childbirth-associated acute exacerbations in the postpartum period. We treated nine MS patients with a history of 12 childbirth-associated acute exacerbations that had occurred 2-9 weeks after previous deliveries. The patients were administered intravenous immunoglobulin (IVIg) at a dose of 0.4 g/kg per day for 5 consecutive days during the Ist week after childbirth and at 6 and 12 weeks thereafter. None of the treated patients relapsed during the 6-month period after delivery. However, three patients had a remote relapse: two at 8 months and one at 10 months after childbirth, but these probably represented the natural course of disease and were not associated with childbirth. We conclude that IVIg treatment may prevent acute childbirth-associated exacerbations in relapsing-remitting MS patients.