Cesarean Sections Prior to 39 Weeks Among Pregnant Patients With Multiple Sclerosis
Mandisa Keswa1, Sana Desai1, Francesca Kamwa Dzukou1, Jessica Smith2, Irogue Igbinosa3, Annette Langer-Gould4
1Kaiser Permanente Bernard J. Tyson School of Medicine, 2Department of Research and Evaluation, Southern California Permanente Medical Group, 3Maternal Fetal Medicine Department of Obstetrics and Gynecology, Stanford University, 4Neurology Department, Los Angeles Medical Center
Objective:

To determine whether pregnant women with MS (pregMS) experience higher rates of non-medically indicated Cesarean sections (C-section) prior to 39 weeks’ gestation (<39w) and whether these were attributed to MS or obstetric indications.

Background:

Though MS is not an indication for C-section, PregMS have higher C-section rates compared to age-matched controls. Whether these are occurring <39w is unclear and important because C-sections <39w increase risks of adverse neonatal outcomes and are not recommended according to obstetric guidelines unless medically indicated.

Design/Methods:
We conducted a case-control study of pregnancies ≥ 20 weeks in pregMS and 2:1 matched from the retrospective, population-based cohort of pregnancies in Kaiser Permanente Southern California 1/1/2009-6/30/2024. Electronic health records were searched for those with C-sections <39w and manually reviewed for outcomes and covariates.
Results:

We identified 600 pregnancies among women with MS and 1199 among controls. C-sections <39w were more frequent in MS pregnancies (n=91, 15.2% MS and n=117, 9.8% controls, p=0.0007). Non-medically indicated C-sections <39w were uncommon and similar between groups (n=22, 3.7% MS and n=34, 2.8% controls, p=0.3386). Among women with C-sections <39w, pregMS were more likely to have a mental health condition (27.5% MS and 2.8% controls) and less likely to have diabetes at pregnancy start. Demographics and comorbidities were otherwise comparable. MS was documented as a pregnancy complication in 24.2% of cases (n=22).The higher proportion of medically indicated C-sections <39w in pregMS (n= 69, 11.5% MS and n=83, 6.9% controls, p=0.001) was driven by more high-risk myomectomies (n=10, 1.7%, p=0.0008) and stalled labor (n=16, 2.7%, p=0.0021) compared to controls (0.3% and 1.4%, respectively).

Conclusions:

These findings are reassuring for women with MS planning pregnancies. Though MS was documented as a pregnancy complication in nearly one-quarter of pregMS, suggesting possible lingering misconceptions among obstetric providers, this did not result in substandard obstetrical care.

10.1212/WNL.0000000000213270
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