Brain MRI Activity During the Year Before Pregnancy Can Predict Long-Term Clinical Worsening in Patients with Multiple Sclerosis
Omri Zveik1, Shahar Kahila1, Netta Levin1, Ariel Rechtmen1, Nitzan Haham1, Adi Vaknin-Dembinsky1
1Faculty of Medicine, Hebrew University of Jerusalem, Department of Neurology and Laboratory of Neuroimmunology, The Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center
Objective:
The aim of the study was to evaluate the correlation between Magnetic Resonance Imaging (MRI) activity in the year before pregnancy and the long-term clinical meaningful worsening in Expanded Disability Status Scale (EDSS).
Background:
While fewer Multiple Sclerosis (MS) relapses occur during pregnancy, relapse risk increases in the early post-partum period. We showed in a previous study a correlation between an active-MRI pre-conception and the early post-partum disease activity as evidenced by MRI activity and relapses. Increased post-partum disease activity may predict a poor long-term prognosis.
Design/Methods:
An observational retrospective case–control study included 141 pregnancies in 99 females with MS. Statistical analyses were used to evaluate the correlation between MRI-activity in the year pre-pregnancy and post-partum clinical worsening during 5-years follow-up. Clustered logistic regression was used to investigate the predictors of 5-years clinical meaningful worsening in EDSS (lt-EDSS).
Results:
We found a significant correlation for an active-MRI pre-pregnancy and lt-EDSS (p=0.0006). EDSS pre-pregnancy and lt-EDSS also significantly correlated (p=0.043). Using a multivariate model, we predicted which females won’t experience long-term clinical deterioration by a stable-MRI pre-pregnancy (89.6% specificity; p=0.012).
Conclusions:
An active-MRI pre-conception is a strong predictor of lt-EDSS and higher annual relapse-rate (ARR) during the follow-up period, regardless of whether the female had clinical evidence of disease activity prior to conception and delivery. Optimizing disease control and achieving both clinical and imaging stability pre-conception and post-delivery may reduce the risk of long-term clinical deterioration.