CIS: reproductive history doesn’t alter long-term MS outcomes

  • Zuluaga MI & al.
  • Neurology
  • 1 Mar 2019

  • International Clinical Digest
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Takeaway

  • Among women with clinically isolated syndrome (CIS), age at menarche, pregnancies, and breastfeeding did not modify long-term prognosis regarding multiple sclerosis (MS).

Why this matters

  • Women are disproportionately affected by MS.
  • Need for information to guide reproductive counseling.

Key results

  • During a median 9.5-year follow-up:
    • 53% developed clinically definite MS (CDMS).
    • 61% met McDonald 2010 MS criteria.
    • 13.4% and 2.6% reached Expanded Disability Status Scale (EDSS) 3.0 and 6.0, respectively.
  • Age at menarche:
    • Not correlated with age at CIS.
    • Not associated with risk for CDMS or EDSS 3.0 or 6.0.
  • Pregnancy before CIS:
    • Reduced risk for CDMS in univariate but not multivariate analysis.
    • Not associated with risk for EDSS 3.0.
  • Pregnancy after CIS:
    • Reduced risk for CDMS, EDSS 3.0 in multivariate analyses (HR, 0.25 [95% CI, 0.16-0.38] and HR, 0.45 [95% CI, 0.23-0.89], respectively) when pregnancy is a baseline variable.
    • Did not reduce risk for either when pregnancy is a time-dependent variable.
  • Breastfeeding did not significantly alter risk for any outcome.

Study design

  • Spanish cross-sectional cohort study of 501 women with CIS.
  • Reproductive history self-reported.
  • Main outcomes: CDMS, McDonald 2010 MS, EDSS 3.0 and 6.0.
  • Funding: Ministry of Economy and Competitiveness of Spain; others.

Limitations

  • Possible selection, recall biases.
  • Potential residual, unmeasured confounding.