Mode of Delivery on Postpartum Well-being for Women with Multiple Sclerosis
Tiffany Cao1, Annika Anderson1, Ayushi Balan1, Stephanie Hsu1, Min Ji Kim1, Maria Houtchens2, Riley Bove1
1University of California, San Francisco, 2Brigham and Women’s Hospital
Objective:

To evaluate the relationship between mode of delivery and postpartum well-being in women with multiple sclerosis (MS).

Background:
Women with neurological conditions, including MS, experience elevated morbidity postpartum. In the general population, depression, sleep disturbance, and fatigue tend to worsen during the postpartum period, and especially following caesarean section (CS) compared with vaginal delivery (VD). Though women with MS have higher risk of these symptoms at baseline, the impact of delivery mode remains unexplored.
Design/Methods:

This is an analysis of a prospective cohort of 41 cis-women with MS from a single academic center who delivered via CS (n=12) or VD (n=29) between 2018 and 2022. Symptoms were assessed one month after delivery using self-reported questionnaires for sleep [Medical Outcomes Study—Sleep Scale (MOS-SS)], fatigue [Epworth Sleepiness Scale (ESS) and Modified Fatigue Impact Scale (MFIS)], and depression [Edinburgh Postnatal Depression Scale (EPDS)]. Scores were compared using two-sample t-tests for continuous variables; significance level was <0.05.

Results:

The main demographic and MS characteristics of the women delivering via CS were similar to those delivering via VD, although more were primiparous (P=0.05). Women with CS reported better sleep adequacy (MOS-SS, P=0.0015), reduced daytime sleepiness (ESS, P=0.017), and decreased fatigue (MFIS, P=0.049, particularly the cognitive fatigue sub-scale, (P=0.032) relative to women with VD. Postpartum depression was not associated with delivery mode.

Conclusions:

Surprisingly, women with MS who delivered via CS reported better well-being postpartum relative to those delivering vaginally. Given the significant and added burden of MS and symptom management faced postpartum by women with MS, CS could represent a “forced rest,” paradoxically improving well-being. Further research is necessary to evaluate this and other possible mechanisms underlying this association. Overall, the current findings highlight the need for tailored postpartum care strategies to improve the well-being of these patients.

10.1212/WNL.0000000000212406
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