Peripartum disease activity in moderately and severely disabled women with multiple sclerosis

Bridget La Monica Ostrem, Annika Anderson, Sarah Conway, Brian C. Healy, Jiwon Oh, Dina Jacobs, Ruth Dobson, Edith Larmon Graham, A. Dessa Sadovnick, Vanessa Zimmerman, Yanqing Liu, Riley Bove, Maria Houtchens*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: The effects of pregnancy on multiple sclerosis (MS) inflammatory activity are not well described in women with moderate to severe disabilities. Objective: To quantify the peripartum annualized relapse rate (ARR) in women with MS with an Expanded Disability Status Scale (EDSS) ≥ 3. Methods: We performed a retrospective cohort study of 85 pregnancies in 74 subjects with preconception EDSS ≥ 3. We quantified peripartum ARR and tested for risk factors predictive of peripartum relapses, postpartum brain magnetic resonance imaging activity (new T2 or gadolinium-enhancing lesions), and disability worsening. Results: There were 74 live births, with a 56% operative delivery rate. In subjects with relapsing-remitting MS, ARR decreased to 0.11 during the third trimester of pregnancy compared to 0.59 in the year preconception and increased to 1.22 in the 3 months postpartum. Women with a higher preconception EDSS had higher odds of postpartum relapses and clinically significant worsening of disability as compared to subjects with a lower EDSS. Conclusions: Moderately to severely disabled women with MS have a lower risk of relapse during pregnancy as compared to preconception, followed by a marked increase postpartum. Further studies are needed to identify ways to reduce peripartum inflammatory activity and disability progression in women with MS with moderate to severe disability.

Original languageEnglish (US)
JournalMultiple Sclerosis Journal - Experimental, Translational and Clinical
Issue number2
StatePublished - Apr 2022


  • Multiple sclerosis
  • breastfeeding
  • disease progression
  • postpartum period
  • pregnancy
  • relapsing-remitting multiple sclerosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience


Dive into the research topics of 'Peripartum disease activity in moderately and severely disabled women with multiple sclerosis'. Together they form a unique fingerprint.

Cite this