Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability

Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability Publisher Pubmed

Shipley J ; Beadnall H N ; Sanfilippo P G ; Yeh W Z ; Horakova D ; Havrdova E K ; Hradilek P ; Kalincik T ; Roos I ; Prat A ; Girard M ; Rous Z ; Pavelek Z ; Gerlach O H H Show All Authors

Shipley J
Beadnall H N
Sanfilippo P G
Yeh W Z
Horakova D
Havrdova E K
Hradilek P
Kalincik T
Roos I
Prat A
Girard M
Rous Z
Pavelek Z
Gerlach O H H
Lechner Scott J
Alroughani R
Ozakbas S
Peterka M
Buzzard K
Skibina O G
Maimone D
Foschi M
Surcinelli A
Karabudak R
Spitaleri D L A
Lugaresi A
Tomassini V
Gouider R
Mrabet S
Ferrando B R
Hodgkinson S
Stourac P
Guimaraes J
John N A
Macdonell R A L
Meca Lallana J E
Butzkueven H
Van Der Walt A
Jokubaitis V G
Varchova M
Duquette P
Libertinova J
Izquierdo G
Eichau S
Patti F
Boz C
Barnett M
Ampapa R
Martinkova A
Ramo Tello C
Grammond P
Van Pesch V
D Amico E
Weinstock Guttman B
Shaygannejad V
Blanco Y
Kuhle J
Grand Maison F
Prevost J
Amato M P
Yamout B
Khoury S J
Terzi M
Oreja Guevara C
Cartechini E
Laureys G
Aguera Morales E
Di Gregorio M
Altintas A
Turkoglu R
D Hooghe M
Solaro C
Soysal A
Cabrera Gomez J A
Habek M
Willekens B
Etemadifar M
Rio M E
Al Harbi T
Kermode A G
Fabis Pedrini M
Carroll W M
Mccombe P
Houskova J
Recmanova E
Stetkarova I
Zakaria M
Shalaby N
Castillo Trivino T
Baghbanian S M
Simu M
Slee M
Massey J
Oh J
Moghadasi A N
De Gans K
Al Asmi A
Saladino M L
Lapointe E
Gobbi C
Petersen T
Bolanos R F
Hughes S
Gray O
Grigoriadis N
Piroska I
Yucesan C
Garber J
Boggild M
Decoo D
Rozsa C
Csepany T
Mcguigan C
Yetkin M F
Deri N
Cristiano E
Vrech C
Shuey N
Hardy T A
Vucic S
Reddel S
Ramanathan S
Field D
Van Wijmeersch B
Cambron M
Cardenas Robledo S
Sanchez Menoyo J L
Kovacs K
Sas A
Dobos E
Singhal B
Chihara N
Cauchi M
Mason D
Alkhaboori J
Kister I

Source: JAMA Network Open Published:2025

Abstract

IMPORTANCE Understanding the association between pregnancy and clinical outcomes in women with moderate to severe multiple sclerosis (MS) disability is crucial for guiding family planning and management strategies. OBJECTIVE To assess peripregnancy relapse activity and disability progression in women with a preconception Expanded Disability Status Scale (EDSS) score of 3 or higher. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study used data from the MSBase Registry, with clinical observations spanning 1984 through 2024. Study cohorts included pregnant women with MS with a preconception EDSS score of 3 or higher (range: 3-10, with higher scores indicating more severe MS-related disability) and propensity score–matched nonpregnant women with MS (controls). MAIN OUTCOMES AND MEASURES The main outcomes were peripregnancy annualized relapse rates (ARRs) and time to 6-month confirmed disability worsening (CDW). RESULTS A total of 1631 women with MS were included, of whom 575 were in the pregnant cohort (median [IQR] age at pregnancy, 32.5 [29.1-36.1] years) and 1056 were in the nonpregnant cohort (median [IQR] age, 32.6 [27.5-37.2] years). The median (range) preconception EDSS score was 3.5 (3.0-7.5). Relapse activity decreased during pregnancy, with a 75% reduction in ARR during the first trimester (rate ratio [RR], 0.25; 95% CI, 0.15-0.43), and increased to 36% above preconception levels in the first 3 months post partum (RR, 1.36; 95% CI, 1.06-1.75). Relapse during pregnancy was associated with a higher preconception ARR (odds ratio [OR], 1.56; 95% CI, 1.10-2.20) and preconception use of natalizumab (OR, 4.42; 95% CI, 1.24-23.57) or fingolimod (OR, 14.07; 95% CI, 2.81-91.30). Older age (OR, 0.92; 95% CI, 0.85-0.99) and continuation of disease-modifying therapy into pregnancy (OR, 0.42; 95% CI, 0.19-1.00) were associated with reduced risk. Disease-modifying therapy reinitiation within 1 month post partum was associated with lower odds of early postpartum relapse (OR, 0.45; 95% CI, 0.23-0.86). There was no significant difference in time to CDW between the pregnant and nonpregnant groups (hazard ratio [HR], 1.15; 95% CI, 0.96-1.38). However, ARR during pregnancy (HR, 1.37; 95% CI, 1.13-1.65) and postpartum EDSS score higher than 4 (HR, 2.69; 95% CI, 1.80-4.03) were associated with shorter time to CDW. CONCLUSIONS AND RELEVANCE In this cohort study, women with moderate to severe MS disability exhibited a pattern of peripregnancy relapse activity similar to that reported in women with less disability. Pregnancy was not associated with worse long-term disability outcomes, although optimizing disease control in the peripregnancy period remained critical. © 2025 American Medical Association. All rights reserved.

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Style	Citing Format
MLA	Shipley J, et al.. "Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability." JAMA Network Open, vol. 8, no. 9, 2025, pp. -.
APA	Shipley J, Beadnall H N, Sanfilippo P G, Yeh W Z, Horakova D, Havrdova E K, Hradilek P, Kalincik T, Roos I, Prat A, Girard M, Rous Z, Pavelek Z, Gerlach O H H, Lechner Scott J, Alroughani R, Ozakbas S, Peterka M, Buzzard K, ... Kister I (2025). Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability. JAMA Network Open, 8(9), -.
Chicago	Shipley J, Beadnall H N, Sanfilippo P G, Yeh W Z, Horakova D, Havrdova E K, Hradilek P, et al.. "Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability." JAMA Network Open 8, no. 9 (2025): -.
Harvard	Shipley J et al. (2025) 'Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability', JAMA Network Open, 8(9), pp. -.
Vancouver	Shipley J, Beadnall H N, Sanfilippo P G, Yeh W Z, Horakova D, Havrdova E K, et al.. Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability. JAMA Network Open. 2025;8(9):-.
BibTex	@article{ author = {Shipley J and Beadnall H N and Sanfilippo P G and Yeh W Z and Horakova D and Havrdova E K and Hradilek P and Kalincik T and Roos I and Prat A and Girard M and Rous Z and Pavelek Z and Gerlach O H H and Lechner Scott J and Alroughani R and Ozakbas S and Peterka M and Buzzard K and Skibina O G and Maimone D and Foschi M and Surcinelli A and Karabudak R and Spitaleri D L A and Lugaresi A and Tomassini V and Gouider R and Mrabet S and Ferrando B R and Hodgkinson S and Stourac P and Guimaraes J and John N A and Macdonell R A L and Meca Lallana J E and Butzkueven H and Van Der Walt A and Jokubaitis V G and Varchova M and Duquette P and Libertinova J and Izquierdo G and Eichau S and Patti F and Boz C and Barnett M and Ampapa R and Martinkova A and Ramo Tello C and Grammond P and Van Pesch V and D Amico E and Weinstock Guttman B and Shaygannejad V and Blanco Y and Kuhle J and Grand Maison F and Prevost J and Amato M P and Yamout B and Khoury S J and Terzi M and Oreja Guevara C and Cartechini E and Laureys G and Aguera Morales E and Di Gregorio M and Altintas A and Turkoglu R and D Hooghe M and Solaro C and Soysal A and Cabrera Gomez J A and Habek M and Willekens B and Etemadifar M and Rio M E and Al Harbi T and Kermode A G and Fabis Pedrini M and Carroll W M and Mccombe P and Houskova J and Recmanova E and Stetkarova I and Zakaria M and Shalaby N and Castillo Trivino T and Baghbanian S M and Simu M and Slee M and Massey J and Oh J and Moghadasi A N and De Gans K and Al Asmi A and Saladino M L and Lapointe E and Gobbi C and Petersen T and Bolanos R F and Hughes S and Gray O and Grigoriadis N and Piroska I and Yucesan C and Garber J and Boggild M and Decoo D and Rozsa C and Csepany T and Mcguigan C and Yetkin M F and Deri N and Cristiano E and Vrech C and Shuey N and Hardy T A and Vucic S and Reddel S and Ramanathan S and Field D and Van Wijmeersch B and Cambron M and Cardenas Robledo S and Sanchez Menoyo J L and Kovacs K and Sas A and Dobos E and Singhal B and Chihara N and Cauchi M and Mason D and Alkhaboori J and Kister I}, title = {Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability}, journal = {JAMA Network Open}, volume = {8}, number = {9}, pages = {-}, year = {2025} }
RIS	TY - JOUR AU - Shipley J AU - Beadnall H N AU - Sanfilippo P G AU - Yeh W Z AU - Horakova D AU - Havrdova E K AU - Hradilek P AU - Kalincik T AU - Roos I AU - Prat A AU - Girard M AU - Rous Z AU - Pavelek Z AU - Gerlach O H H AU - Lechner Scott J AU - Alroughani R AU - Ozakbas S AU - Peterka M AU - Buzzard K AU - Skibina O G AU - Maimone D AU - Foschi M AU - Surcinelli A AU - Karabudak R AU - Spitaleri D L A AU - Lugaresi A AU - Tomassini V AU - Gouider R AU - Mrabet S AU - Ferrando B R AU - Hodgkinson S AU - Stourac P AU - Guimaraes J AU - John N A AU - Macdonell R A L AU - Meca Lallana J E AU - Butzkueven H AU - Van Der Walt A AU - Jokubaitis V G AU - Varchova M AU - Duquette P AU - Libertinova J AU - Izquierdo G AU - Eichau S AU - Patti F AU - Boz C AU - Barnett M AU - Ampapa R AU - Martinkova A AU - Ramo Tello C AU - Grammond P AU - Van Pesch V AU - D Amico E AU - Weinstock Guttman B AU - Shaygannejad V AU - Blanco Y AU - Kuhle J AU - Grand Maison F AU - Prevost J AU - Amato M P AU - Yamout B AU - Khoury S J AU - Terzi M AU - Oreja Guevara C AU - Cartechini E AU - Laureys G AU - Aguera Morales E AU - Di Gregorio M AU - Altintas A AU - Turkoglu R AU - D Hooghe M AU - Solaro C AU - Soysal A AU - Cabrera Gomez J A AU - Habek M AU - Willekens B AU - Etemadifar M AU - Rio M E AU - Al Harbi T AU - Kermode A G AU - Fabis Pedrini M AU - Carroll W M AU - Mccombe P AU - Houskova J AU - Recmanova E AU - Stetkarova I AU - Zakaria M AU - Shalaby N AU - Castillo Trivino T AU - Baghbanian S M AU - Simu M AU - Slee M AU - Massey J AU - Oh J AU - Moghadasi A N AU - De Gans K AU - Al Asmi A AU - Saladino M L AU - Lapointe E AU - Gobbi C AU - Petersen T AU - Bolanos R F AU - Hughes S AU - Gray O AU - Grigoriadis N AU - Piroska I AU - Yucesan C AU - Garber J AU - Boggild M AU - Decoo D AU - Rozsa C AU - Csepany T AU - Mcguigan C AU - Yetkin M F AU - Deri N AU - Cristiano E AU - Vrech C AU - Shuey N AU - Hardy T A AU - Vucic S AU - Reddel S AU - Ramanathan S AU - Field D AU - Van Wijmeersch B AU - Cambron M AU - Cardenas Robledo S AU - Sanchez Menoyo J L AU - Kovacs K AU - Sas A AU - Dobos E AU - Singhal B AU - Chihara N AU - Cauchi M AU - Mason D AU - Alkhaboori J AU - Kister I TI - Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability JO - JAMA Network Open VL - 8 IS - 9 SP - EP - PY - 2025 ER -

Style

Citing Format

MLA

Shipley J, et al.. "Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability." JAMA Network Open, vol. 8, no. 9, 2025, pp. -.

APA

Shipley J, Beadnall H N, Sanfilippo P G, Yeh W Z, Horakova D, Havrdova E K, Hradilek P, Kalincik T, Roos I, Prat A, Girard M, Rous Z, Pavelek Z, Gerlach O H H, Lechner Scott J, Alroughani R, Ozakbas S, Peterka M, Buzzard K, ... Kister I (2025). Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability. JAMA Network Open, 8(9), -.

Chicago

Shipley J, Beadnall H N, Sanfilippo P G, Yeh W Z, Horakova D, Havrdova E K, Hradilek P, et al.. "Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability." JAMA Network Open 8, no. 9 (2025): -.

Harvard

Shipley J et al. (2025) 'Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability', JAMA Network Open, 8(9), pp. -.

Vancouver

Shipley J, Beadnall H N, Sanfilippo P G, Yeh W Z, Horakova D, Havrdova E K, et al.. Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability. JAMA Network Open. 2025;8(9):-.

BibTex

@article{ author = {Shipley J and Beadnall H N and Sanfilippo P G and Yeh W Z and Horakova D and Havrdova E K and Hradilek P and Kalincik T and Roos I and Prat A and Girard M and Rous Z and Pavelek Z and Gerlach O H H and Lechner Scott J and Alroughani R and Ozakbas S and Peterka M and Buzzard K and Skibina O G and Maimone D and Foschi M and Surcinelli A and Karabudak R and Spitaleri D L A and Lugaresi A and Tomassini V and Gouider R and Mrabet S and Ferrando B R and Hodgkinson S and Stourac P and Guimaraes J and John N A and Macdonell R A L and Meca Lallana J E and Butzkueven H and Van Der Walt A and Jokubaitis V G and Varchova M and Duquette P and Libertinova J and Izquierdo G and Eichau S and Patti F and Boz C and Barnett M and Ampapa R and Martinkova A and Ramo Tello C and Grammond P and Van Pesch V and D Amico E and Weinstock Guttman B and Shaygannejad V and Blanco Y and Kuhle J and Grand Maison F and Prevost J and Amato M P and Yamout B and Khoury S J and Terzi M and Oreja Guevara C and Cartechini E and Laureys G and Aguera Morales E and Di Gregorio M and Altintas A and Turkoglu R and D Hooghe M and Solaro C and Soysal A and Cabrera Gomez J A and Habek M and Willekens B and Etemadifar M and Rio M E and Al Harbi T and Kermode A G and Fabis Pedrini M and Carroll W M and Mccombe P and Houskova J and Recmanova E and Stetkarova I and Zakaria M and Shalaby N and Castillo Trivino T and Baghbanian S M and Simu M and Slee M and Massey J and Oh J and Moghadasi A N and De Gans K and Al Asmi A and Saladino M L and Lapointe E and Gobbi C and Petersen T and Bolanos R F and Hughes S and Gray O and Grigoriadis N and Piroska I and Yucesan C and Garber J and Boggild M and Decoo D and Rozsa C and Csepany T and Mcguigan C and Yetkin M F and Deri N and Cristiano E and Vrech C and Shuey N and Hardy T A and Vucic S and Reddel S and Ramanathan S and Field D and Van Wijmeersch B and Cambron M and Cardenas Robledo S and Sanchez Menoyo J L and Kovacs K and Sas A and Dobos E and Singhal B and Chihara N and Cauchi M and Mason D and Alkhaboori J and Kister I}, title = {Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability}, journal = {JAMA Network Open}, volume = {8}, number = {9}, pages = {-}, year = {2025} }

RIS

TY - JOUR
AU - Shipley J
AU - Beadnall H N
AU - Sanfilippo P G
AU - Yeh W Z
AU - Horakova D
AU - Havrdova E K
AU - Hradilek P
AU - Kalincik T
AU - Roos I
AU - Prat A
AU - Girard M
AU - Rous Z
AU - Pavelek Z
AU - Gerlach O H H
AU - Lechner Scott J
AU - Alroughani R
AU - Ozakbas S
AU - Peterka M
AU - Buzzard K
AU - Skibina O G
AU - Maimone D
AU - Foschi M
AU - Surcinelli A
AU - Karabudak R
AU - Spitaleri D L A
AU - Lugaresi A
AU - Tomassini V
AU - Gouider R
AU - Mrabet S
AU - Ferrando B R
AU - Hodgkinson S
AU - Stourac P
AU - Guimaraes J
AU - John N A
AU - Macdonell R A L
AU - Meca Lallana J E
AU - Butzkueven H
AU - Van Der Walt A
AU - Jokubaitis V G
AU - Varchova M
AU - Duquette P
AU - Libertinova J
AU - Izquierdo G
AU - Eichau S
AU - Patti F
AU - Boz C
AU - Barnett M
AU - Ampapa R
AU - Martinkova A
AU - Ramo Tello C
AU - Grammond P
AU - Van Pesch V
AU - D Amico E
AU - Weinstock Guttman B
AU - Shaygannejad V
AU - Blanco Y
AU - Kuhle J
AU - Grand Maison F
AU - Prevost J
AU - Amato M P
AU - Yamout B
AU - Khoury S J
AU - Terzi M
AU - Oreja Guevara C
AU - Cartechini E
AU - Laureys G
AU - Aguera Morales E
AU - Di Gregorio M
AU - Altintas A
AU - Turkoglu R
AU - D Hooghe M
AU - Solaro C
AU - Soysal A
AU - Cabrera Gomez J A
AU - Habek M
AU - Willekens B
AU - Etemadifar M
AU - Rio M E
AU - Al Harbi T
AU - Kermode A G
AU - Fabis Pedrini M
AU - Carroll W M
AU - Mccombe P
AU - Houskova J
AU - Recmanova E
AU - Stetkarova I
AU - Zakaria M
AU - Shalaby N
AU - Castillo Trivino T
AU - Baghbanian S M
AU - Simu M
AU - Slee M
AU - Massey J
AU - Oh J
AU - Moghadasi A N
AU - De Gans K
AU - Al Asmi A
AU - Saladino M L
AU - Lapointe E
AU - Gobbi C
AU - Petersen T
AU - Bolanos R F
AU - Hughes S
AU - Gray O
AU - Grigoriadis N
AU - Piroska I
AU - Yucesan C
AU - Garber J
AU - Boggild M
AU - Decoo D
AU - Rozsa C
AU - Csepany T
AU - Mcguigan C
AU - Yetkin M F
AU - Deri N
AU - Cristiano E
AU - Vrech C
AU - Shuey N
AU - Hardy T A
AU - Vucic S
AU - Reddel S
AU - Ramanathan S
AU - Field D
AU - Van Wijmeersch B
AU - Cambron M
AU - Cardenas Robledo S
AU - Sanchez Menoyo J L
AU - Kovacs K
AU - Sas A
AU - Dobos E
AU - Singhal B
AU - Chihara N
AU - Cauchi M
AU - Mason D
AU - Alkhaboori J
AU - Kister I
TI - Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability
JO - JAMA Network Open
VL - 8
IS - 9
SP -
EP -
PY - 2025
ER -

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