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Data indicate potential favorable long-term effect of childbirth on MS course

Wednesday, February 03 2010 | Comments

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What's This? Among women with multiple sclerosis (MS), those who have children--particularly those who have children after MS onset--seem to experience a more benign disease course relative to women who do not give birth, study results indicate.

Researchers evaluated the long-term effects of childbirth in 330 women with MS; the mean duration of MS was 17.7 years, and 55% of the women had an Expanded Disability Status Scale (EDSS) score of >=6. Of these women, 80 had no children, 170 had given birth to >=1 child before the onset of MS, 61 had >=1 child after MS onset, and 19 had children both before and after MS onset. Among these 4 groups, the investigators compared the time to an EDSS score of 6 (ie, the patient requires intermittent or unilateral constant assistance of a cane, crutch, or brace to walk approximately 100 m, with or without resting) and age at an EDSS score of 6.

The time to an EDSS score of 6 differed significantly among the 4 groups (P<.001), primarily because of differences between the women who did and did not have children after MS onset. The median time to an EDSS score of 6 was 15 years (95% CI, 12-18 years) among those with no children, 13 years (95% CI, 11-15 years) among those who had children before MS onset, 23 years (95% CI, 20-26 years) among those who had children after MS onset, and 22 years (95% CI, 20-24 years) among those who had children before and after MS onset.

In an analysis that adjusted for age at MS onset, the hazard ratio (HR) for an EDSS score of 6 was 0.61 (95% CI, 0.37-0.99; P=.049) among the women who had children only after MS onset relative to the women with no children. The hazard ratio for an EDSS score of 6 was 0.66 (95% CI, 0.47-0.95; P=.023) among the women who had children at any time relative to the women with no children.

Similar patterns were observed in an analysis that evaluated the age at which an EDSS score of 6 was reached (HR, 0.57 [95% CI, 0.35-0.94]; P=.027 and HR, 0.68 [0.48-0.97]; P=.032, respectively).

To minimize the potential confounding impact of age at MS onset, the researchers conducted a separate analysis restricted to patients with disease onset before age 30 years. The findings supported the primary analysis; the median age at which an EDSS score of 6 was reached was 43 years (95% CI, 41-45 years) among the women who had their first children after MS onset, versus 37 years (95% CI, 32-42 years) among the women with no children. The differences among the 4 groups were not statistically significant, although the investigators noted that this might have been because of the small sample sizes in this analysis.

The study authors acknowledged several limitations to the study, including its small size, the restriction of data collection to live births (with no data for the overall number of pregnancies), the lack of longitudinal data for disease severity, and the lack of information about the timing and duration of immunomodulatory therapy.

In addition, the researchers acknowledged that they could not exclude the possibility that patients with more aggressive disease might have been less likely to have children.

Nonetheless, they concluded that the data suggest a possibly beneficial effect of childbirth after MS onset on disease course and indicate that an unfavorable long-term effect on disability is unlikely. (D'hooghe MB, et al. J Neurol Neurosurg Psychiatry 2010;81:38-41.)

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