Objective:

To evaluate Multiple Sclerosis (MS) relapses/MRI activity around nonviable pregnancy loss.

Background:

MS predominantly affects women of childbearing age. Research suggests MS does not increase miscarriage rates (beyond the general population’s 15-20% in first trimester), however, data remains limited on MS outcomes related to nonviable pregnancy loss. Specifically, clinical and radiographic relapses after miscarriage and the influence of pre-conception disease-modifying therapies (DMT) on relapses has not been thoroughly studied.

Design/Methods:

Retrospective chart review was conducted at University of Colorado focusing on women with MS (wwMS) who experienced documented pregnancy loss between 2013-2023. This included spontaneous abortions, elective terminations, and ectopic pregnancies. Only those with documented neurologic care for the year before conception and the year after were included. Patients with incomplete data were excluded.

Results:

Preliminary analysis identified 16 wwMS and 18 nonviable pregnancies. Among them, 94% had relapsing-remitting MS diagnosis, with an average diagnosis duration of 8.4 years prior to conception. The cohort was predominantly Caucasian (81%) and non-Hispanic (87.5%), with an average conception age of 33.3 years. Of the 18 nonviable outcomes, 67% were spontaneous abortions, occurring at an average of 7.31 weeks. Other outcomes included ectopic pregnancies (17%), elective terminations due to genetic disorders (11%), and one molar pregnancy (5%). Half were on anti-CD20 therapy pre-conception, noting that 48% of all childbearing wwMS are on anti-CD20 therapies in our clinic. There were four clinical relapses in the year prior to conception, but none occurred during pregnancy or within the postpartum year. Asymptomatic radiologic changes were observed in 17% of postpartum MRIs.

Conclusions:

Findings suggest spontaneous abortion is the most common nonviable pregnancy outcome among wwMS, aligning with general population trends. Postpartum relapse rates were lower than pre-conception rates, with minimal radiologic changes noted. Given the small sample size, further analysis with additional participant recruitment is planned and will be presented.