Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: The Italian cohort study

Luisa Pastò, Emilio Portaccio, Angelo Ghezzi, Bahia Hakiki, Marta Giannini, Lorenzo Razzolini, Elisa Piscolla, Laura De Giglio, Carlo Pozzilli, Damiano Paolicelli, Maria Trojano, Maria Giovanna Marrosu, Francesco Patti, Loredana La Mantia, Gian Luigi Mancardi, Claudio Solaro, Rocco Totaro, Maria Rosaria Tola, Valeria Di Tommaso, Alessandra LugaresiLucia Moiola, Vittorio Martinelli, Giancarlo Comi, Maria Pia Amato

Research output: Contribution to journalArticle

Abstract

Background: Few studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women with Multiple Sclerosis (MS).The objective of this study was to assess the impact of epidural analgesia (EA) and caesarean delivery (CD) on the risk of post-partum relapses and disability in women with MS.Methods: In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and EA. The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis.Results: We collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5±3.1 years). One hundred and fifty-five patients (44.4%) underwent CD and 65 (18.5%) EA. In the multivariate analysis neither CD, nor EA were associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95% CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95% CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, CD and EA were not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95% CI 2.0-8.2; p

Original languageEnglish
Article number165
JournalBMC Neurology
Volume12
DOIs
Publication statusPublished - Dec 31 2012

Keywords

  • Caesarean delivery
  • Epidural analgesia
  • Multiple sclerosis
  • Pregnancy

ASJC Scopus subject areas

  • Clinical Neurology

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    Pastò, L., Portaccio, E., Ghezzi, A., Hakiki, B., Giannini, M., Razzolini, L., Piscolla, E., De Giglio, L., Pozzilli, C., Paolicelli, D., Trojano, M., Marrosu, M. G., Patti, F., La Mantia, L., Mancardi, G. L., Solaro, C., Totaro, R., Tola, M. R., Di Tommaso, V., ... Amato, M. P. (2012). Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: The Italian cohort study. BMC Neurology, 12, [165]. https://doi.org/10.1186/1471-2377-12-165