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Brain MRI activity during the year before pregnancy can predict long-term clinical worsening in patients with Multiple Sclerosis

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Abstract

Background

Pregnancy has been observed to reduce the frequency of relapses in Multiple Sclerosis (MS) patients, but the relapse risk tends to increase during the early post-partum period. Increased pre- and post-partum disease activity may predict a poor long-term prognosis. This study aimed to evaluate the correlation between magnetic resonance imaging (MRI) activity during the year before pregnancy and long-term clinically meaningful worsening in Expanded Disability Status Scale (EDSS).

Methods

This observational, retrospective, case–control study included 141 pregnancies in 99 females with MS. Statistical analyses were used to evaluate the correlation between MRI activity during the year pre-pregnancy and post-partum clinical worsening during a 5-year follow-up. Clustered logistic regression was used to investigate the predictors of 5-year clinically meaningful worsening in EDSS (lt-EDSS).

Results

We found a significant correlation between an active MRI pre-pregnancy and lt-EDSS (p = 0.0006). EDSS pre-pregnancy and lt-EDSS were also significantly correlated (p = 0.043). Using a multivariate model, we predicted which females would not experience long-term clinical deterioration by a stable MRI pre-pregnancy (92.7% specificity; p = 0.004).

Conclusions

An active MRI pre-conception is a strong predictor of lt-EDSS and a higher annual relapse rate 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 imaging stability prior to conception may reduce the risk of long-term clinical deterioration.

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Data availability

Anonymized data are available from the corresponding author, on reasonable request.

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Acknowledgements

The authors thank Tali Bdolach-Abram, Faculty of Medicine, Hebrew University of Jerusalem, Israel, for statistical consultation.

Funding

No funding was received to assist with the preparation of this manuscript.

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Author notes

  1. Shahar Kahila and Omri Zveik contributed equally to the manuscript and share the first authorship.

    Tal Imbar and Adi Vaknin-Dembinsky contributed equally to the manuscript and share the last authorship.

Authors and Affiliations

  1. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Shahar Kahila, Omri Zveik, Netta Levin, Livnat Brill, Ariel Rechtman, Nitzan Haham, Tal Imbar & Adi Vaknin-Dembinsky

  2. Department of Neurology and Laboratory of Neuroimmunology, The Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Ein–Kerem, P.O.B. 12000, 91120, Jerusalem, Israel

    Shahar Kahila, Omri Zveik, Netta Levin, Livnat Brill, Ariel Rechtman, Nitzan Haham & Adi Vaknin-Dembinsky

  3. Department of Military Medicine and “Tzameret”, Faculty of Medicine, Hebrew University of Jerusalem, and Medical Corps, Israel Defense Forces, Jerusalem, Israel

    Shahar Kahila

  4. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Ein–Kerem, 91120, Jerusalem, Israel

    Tal Imbar

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Contributions

Shahar Kahila: Investigation, Data Curation, Formal analysis, Writing—Original Draft. Omri Zveik: Investigation, Methodology, Validation, Data Curation, Formal analysis, Visualization, Writing—Original Draft, Writing—Review & Editing. Netta Levin: Resources, Writing—Review & Editing. Livnat Brill: Writing—Review & Editing. Ariel Rechtman: Formal analysis. Nitzan Haham: Formal analysis. Tal Imber: Conceptualization, Methodology, Supervision, Writing—Original Draft, Writing—Review & Editing. Adi Vaknin-Dembinsky: Conceptualization, Methodology, Supervision, Writing—Original Draft, Writing—Review & Editing.

Corresponding author

Correspondence to Adi Vaknin-Dembinsky.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by Hadassah Medical Organization Ethics Committee (0376–18-HMO). Written informed consent was not required due to the retrospective nature of the study.

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Kahila, S., Zveik, O., Levin, N. et al. Brain MRI activity during the year before pregnancy can predict long-term clinical worsening in patients with Multiple Sclerosis. Neurol Sci 44, 3989–3996 (2023). https://doi.org/10.1007/s10072-023-06909-3

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  • DOI: https://doi.org/10.1007/s10072-023-06909-3

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