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Abstract：
Background and Objective: Pregnancy in mothers with multiple sclerosis (MS) commonly results in significant changes in disease activity and changes in clinical care, including the discontinuation of disease modifying therapy (DMT). This study aimed at understanding the clinical and patient-reported outcomes (PROs) before, during and 1-year after delivery. Materials and Methods: A total of 30 pregnant mothers with MS were recruited as part of the study. Clinical (relapse activity and disability changes), PRO information and MRI outcomes were collected on four separate visits: one baseline visit-0-30 days post-delivery; and 3 follow-up visits at week 24, week 36 and week 52 from the baseline. PRO was assessed using a validated questionnaire called the Fatigue Scale for Motor and Cognitive Function (FSMC). The MRI scans were analyzed, and the count of new T2 lesions and/or contrast-enhancing lesions was determined. Results: The average time between delivery and the start of DMT was 142.5 days. Relapse activity before the pregnancy was numerically linked with the activity during the pregnancy, where up to 57.1% of the activity during pregnancy occurred in pwMS with previously active disease before conception (statistically trending with p = 0.073). The relapse activity after the pregnancy occurred twice as often in pwMS whose MS was clinically active before conception. All five pwMS who experienced a relapse prior to the pregnancy experienced worsening in their physical PRO domain. Conclusions: Pre-pregnancy activity is crucial in the screening of mothers with MS at risk for post-partum relapses, worsening of clinical disability and/or PRO measures. A post-partum MS period may benefit from the routine PRO utilization and screening for its worsening. The inflammatory activity during pregnancy was not associated with short-term disease progression.
摘要：
背景与目的:多发性硬化(MS)母亲妊娠常导致疾病活动性和临床护理的显著变化,包括停止疾病改善治疗（DMT）。这项研究旨在了解之前的临床和患者报告的结果（PRO），在交付期间和交付后1年。材料和方法：作为研究的一部分，招募了30名MS孕妇。临床（复发活动和残疾变化），在四次单独的访视中收集PRO信息和MRI结果:一次基线访视-分娩后0-30天;以及从基线开始的第24周、第36周和第52周的3次随访。PRO使用经过验证的问卷进行评估，该问卷称为运动和认知功能疲劳量表（FSMC）。对MRI扫描进行了分析,并确定新的T2病变和/或对比增强病变的计数。结果：分娩与DMT开始之间的平均时间为142.5天。怀孕前的复发活动与怀孕期间的活动在数字上相关，其中怀孕期间高达57.1％的活动发生在怀孕前先前患有活动性疾病的pwMS中（统计学趋势为p=0.073）。妊娠后复发活动的发生频率是pwMS的两倍，pwMS在受孕前具有临床活性。在怀孕前经历复发的所有五个pwMS在其身体PRO领域经历了恶化。结论：孕前活动对于筛查有产后复发风险的MS母亲至关重要。临床残疾恶化和/或PRO措施。产后MS期可能受益于常规PRO利用和筛查其恶化。妊娠期间的炎症活动与短期疾病进展无关。
