Abortion induces reactivation of inflammation in relapsing-remitting multiple sclerosis

Doriana Landi, Paolo Ragonese, Luca Prosperini, Viviana Nociti, Shalom Haggiag, Antonio Cortese, Roberta Fantozzi, Simona Pontecorvo, Elisabetta Ferraro, Maria Chiara Buscarinu, Giorgia Mataluni, Fabrizia Monteleone, Marco Salvetti, Giancarlo Di Battista, Ada Francia, Enrico Millefiorini, Claudio Gasperini, Massimiliano Mirabella, Giuseppe Salemi, Laura BoffaCarlo Pozzilli, Diego Centonze, Girolama Alessandra Marfia

Research output: Contribution to journalArticle

Abstract

Objective: To investigate clinical and radiological outcomes of women with relapsing-remitting multiple sclerosis (RRMS) undergoing abortion. Methods: An independent, multicentre retrospective study was conducted collecting data from eight Italian MS centres. We compared the preconception and postabortion annualised relapse rate (ARR) and number of Gadolinium enhancing (Gd+) lesions, by analyses of covariance. Variables associated with postabortion clinical and MRI activity were investigated using Poisson regression models; each abortion was considered as a statistical unit. Results: From 1995 to 2017, we observed 188 abortions (17 elective) in 153 women with RRMS. Abortions occurred after a mean time of 9.5 (4.4) weeks from estimated conception date. In 86 events out of 188, conception happened during treatment with disease modifying drugs. The mean postabortion ARR (0.63±0.74) was significantly increased (p=0.037) compared with the preconception year (0.50±0.71) as well as the postabortion mean number of new Gd+ lesions (0.77±1.40 vs 0.39±1.04; p=0.004). Higher likelihood of relapses was predicted by higher preconception ARR, discontinuation of preconception treatment and elective abortion; the occurrence of new Gd+ lesions was associated with higher preconception number of active lesions, discontinuation of preconception treatment, shorter length of pregnancy maintenance and elective abortion. Conclusions: Abortion was associated with clinical and radiological inflammatory rebound remarkably in the first 12 months postevent. Deregulated proinflammatory processes arising at the early stages of pregnancy might play a role both in MS reactivation and abortion. Women with MS should be counselled about these risks of abortion and followed up accordingly.

Original languageEnglish
Pages (from-to)1272-1278
Number of pages7
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume89
Issue number12
DOIs
Publication statusPublished - Dec 1 2018

Keywords

  • abortion
  • annualised relapse rate
  • gadolinium enhancing lesion
  • multiple sclerosis
  • pregnancy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

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    Landi, D., Ragonese, P., Prosperini, L., Nociti, V., Haggiag, S., Cortese, A., Fantozzi, R., Pontecorvo, S., Ferraro, E., Buscarinu, M. C., Mataluni, G., Monteleone, F., Salvetti, M., Di Battista, G., Francia, A., Millefiorini, E., Gasperini, C., Mirabella, M., Salemi, G., ... Marfia, G. A. (2018). Abortion induces reactivation of inflammation in relapsing-remitting multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry, 89(12), 1272-1278. https://doi.org/10.1136/jnnp-2018-318468