The Role of Pregnancy in Relapsing-Remitting Ms Prognosis: a Five-Year Study

Abstract

Introduction: Multiple sclerosis (MS) frequently affects women during their reproductive years, leading to growing interest in the interaction between pregnancy and MS progression. The relationship between pregnancy and MS prognosis has been widely studied, yet long-term outcomes remain controversial, with studies presenting conflicting results. Aim: This study aims to assess the long-term impact of pregnancy on MS prognosis by examining relapse rates, Expanded Disability Status Scale (EDSS) scores, and MRI activity over three and five years after delivery. Method: A total of 111 women with MS (wwMS) who delivered either preterm or at full term after MS diagnosis were retrospectively studied. The participants were grouped into those who experienced no relapses during pregnancy (NRG) and those who did (RG). A control group of 85 non-pregnant wwMS (NPG) with matched demographic and clinical characteristics was included for comparative analysis. Clinical data such as relapse rates, EDSS scores, and MRI findings were collected and analyzed statistically to determine the potential impact of pregnancy on MS. Result: Of the women who delivered post-MS diagnosis, 11 experienced relapses during pregnancy. There were no significant differences between the three groups regarding prepregnancy annualized relapse rate, EDSS scores, age at diagnosis, age at pregnancy, oligoclonal band positivity, first symptom localization, or disease-modifying therapy use (p > 0.05). Both the NRG and RG groups experienced significantly more relapses compared to the NPG group during the first three and five years post-delivery (p < 0.05). Additionally, the RG group had a higher relapse rate in the third year after delivery compared to the NRG group (p < 0.05). Conclusion: Having a delivery after an MS diagnosis is associated with increased relapse activity, particularly within the first three years postpartum. However, this heightened relapse activity does not appear to contribute to long-term disability accumulation and MRI activity in wwMS. These findings support the importance of individualized postpartum monitoring. © 2025 Elsevier B.V.