MS og barnsburður : Sjúkdómsvirkni og útkoma meðgöngu og fæðingar

Abstract

INNGANGUR MS (multiple sclerosis) er langvinnur bólgusjúkdómur í miðtaugakerfi sem einkennist af köstum, einkum hjá ungu fólki, konum frekar en körlum. Meðgöngu- og fæðingarsaga íslenskra kvenna með MS hefur ekki verið rannsökuð áður. Markmið rannsóknarinnar var tvíþætt, annars vegar að skoða sjúkdómsmynd MS á meðgöngu og fyrstu mánuðum eftir fæðingu og hins vegar að kanna útkomu meðgöngu og fæðingar kvenna með MS og bera saman við hóp kvenna sem ekki hafa greinst með MS eða annan langvinnan sjúkdóm. EFNIVIÐUR OG AÐFERÐIR Afturskyggn rannsókn á gögnum úr sjúkraskrá Landspítala og Fæðingaskráningu Embættis landlæknis sem náði til kvenna með greininguna MS (ICD-10: G35) á árunum 2009-2018 og fæðinga þeirra á tímabilinu 1999-2018, alls 91 konu og 137 fæðinga. NIÐURSTÖÐUR Köstum fækkaði á fyrsta og öðrum þriðjungi meðgöngu miðað við árið fyrir þungun. Rúmlega helmingur kvennanna var á fyrirbyggjandi lyfjameðferð fyrir meðgöngu og hættu þær allar meðferðinni um eða fyrir getnað. Konur með MS fæddu oftar með keisaraskurði án fæðingarsóttar. Meðgöngulengd kvenna með MS var sambærileg við samanburðarhóp þegar sótt hófst sjálfkrafa. Ekki var munur á fjölda léttbura eða þungbura milli hópa. Apgar-stigun var sambærileg milli hópa. ÁLYKTUN Við teljum að rannsókn okkar endurspegli vel meðgöngu- og fæðingarsögu kvenna með MS á Íslandi og að niðurstöður sýni að þær skeri sig lítt úr almennu þýði. Niðurstöður okkar samrýmast erlendum rannsóknum um lægri kastatíðni á meðgöngu en munurinn er þó sá að í okkar rannsókn eru þau áhrif bundin við fyrsta og annan þriðjung meðgöngu. Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system which affects young people, especially women. The aim of the study was to examine the disease profile of MS during pregnancy and postpartum as well as pregnancy outcomes in women with MS compared to a control group. Such a study has not been conducted in Iceland before. Material and methods: A hospital based retrospective study with data from the Icelandic Medical Birth Register and medical records from Landspitali University Hospital including women with MS diagnosis during 2009-2018 and their deliveries through 1999-2018, a total of 91 women and 137 births. Results: Relapse frequency decreased during pregnancy compared to the preceding year. Over half of the women received disease modifying drugs before pregnancy, all stopped treatment before or shortly after conception. Women in the study group underwent cesarean sections before labor more frequently than the control group. The gestational length was comparable between the groups when labor was spontaneous. The numbers of heavy- and lightweight newborns as well as Apgar scores were alike in both groups. Conclusion: We believe that our study reflects actual pregnancy outcome among Icelandic women with MS and our results show that their pregnancies and deliveries do not differ in any major aspect from the general population. Our findings agree with previous studies in that pregnancy protects against MS relapses although in our study this is confined to the first and second trimester.

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system which affects young people, especially women. The aim of the study was to examine the disease profile of MS during pregnancy and postpartum as well as pregnancy outcomes in women with MS compared to a control group. Such a study has not been conducted in Iceland before. MATERIAL AND METHODS: A hospital based retrospective study with data from the Icelandic Medical Birth Register and medical records from Landspitali University Hospital including women with MS diagnosis during 2009-2018 and their deliveries through 1999-2018, a total of 91 women and 137 births. RESULTS: Relapse frequency decreased during pregnancy compared to the preceding year. Over half of the women received disease modifying drugs before pregnancy, all stopped treatment before or shortly after conception. Women in the study group underwent cesarean sections before labor more frequently than the control group. The gestational length was comparable between the groups when labor was spontaneous. The numbers of heavy- and lightweight newborns as well as Apgar scores were alike in both groups. CONCLUSION: We believe that our study reflects actual pregnancy outcome among Icelandic women with MS and our results show that their pregnancies and deliveries do not differ in any major aspect from the general population. Our findings agree with previous studies in that pregnancy protects against MS relapses although in our study this is confined to the first and second trimester.