背景:多发性硬化症似乎不会对胎儿和新生儿结局产生不利影响,尽管一些研究报告了平均出生体重和身长的可能减少,和更高的早产发生率,主要与怀孕期间暴露于疾病改善药物(DMD)有关。与健康女性相比,多发性硬化症母亲的新生儿的宫内胎儿生长和产后躯体发育的数据很少。由于这些原因,我们决定调查胎儿的生长情况,新生儿人体测量参数,MS母亲后代的出生后体细胞发育长达12个月。
方法:这项回顾性队列研究包括211名多发性硬化症患者,和384名健康妇女配对的母亲年龄和产次作为对照。胎儿生物特征参数(双顶直径,头围,腹围,和股骨长度)在妊娠中期(妊娠30-34周)测量的是从存储在医院进行的超声检查结果的部门(EcoPlus*)的计算机化数据库中检索的。新生儿测量(体重,出生时的身长和头围)是从医院的计算机化产科和新生儿数据库(Trackare*和Remote*数据库)获得的;出生后6个月和12个月的测量值是从本地区家庭儿科医生的区域数据库(ECWMED*)获得的。
结果:两组的所有胎儿参数均无差异,根据胎龄,以百分位数表示(双顶直径:p=0.40;头围:p=0.40;腹围:p=0.32;股骨长度:p=0.32)。分娩时的胎龄没有差异,出生体重,观察两组新生儿低出生体重和小于胎龄儿的发生率。在多发性硬化组中,剖宫产(p=0.01)和晚期早产(妊娠少于37周,p=0.001)进行了登记。出生后体重(F=0.53;p值=0.590)和长度(F=0.44;p值=0.645)的增长趋势在两组之间是重叠的。头围的生长趋势表现为轻微的,在6个月的生命中,来自多发性硬化症母亲的婴儿的头围没有显着增加,但两组12个月时的值相似(F=0.85;p值=0.427).此外,出生后体重增加的趋势(F=1.016;p值=0.331),身长(F=2.001;p值=0.146)和头围(F=1.591;p值=0.212)出生的新生儿/婴儿(从出生到12个月的生命)谁母乳喂养,没有的母亲,与对照组相似。
结论:妊娠多发性硬化症似乎不会影响胎儿生长和后代出生后第一年的发育。我们认为这些结果代表了在孕前咨询期间为患者提供的重要且令人放心的信息。
BACKGROUND: Multiple sclerosis does not seem to adversely affect fetal and neonatal outcomes, although some studies reported a possible reduction in mean birth weight and length, and a higher incidence of preterm delivery, mainly in relation to the exposure to disease-modifying drugs (DMDs) during pregnancy. Few data are available on intrauterine fetal growth and postnatal somatic development of newborns from mothers with multiple sclerosis compared to those from healthy women. For these reasons, we decided to investigate fetal growth, neonatal anthropometric parameters, and postnatal somatic development up to 12 months of life in offsprings from MS mothers.
METHODS: This retrospective cohort study included 211 women with multiple sclerosis, and 384 healthy women paired for maternal age and parity as controls. Fetal biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) measured during the third trimester of pregnancy (30-34 weeks\' gestation) were retrieved from the computerized database of the Department (EcoPlus*) where the results of ultrasound exams performed in the hospital are stored. Newborn measurements (weight, length and head circumference) at birth were obtained from the hospital\'s computerized obstetric and neonatal database (Trackare* and Remote* data base); measurements at 6 and 12 months of life were obtained from the regional database (ECWMED*) of family pediatricians of our region.
RESULTS: No differences between the two groups were observed for all the fetal parameters considered, expressed as centiles of growth according to gestational age (biparietal diameter: p = 0.40; head circumference: p = 0.40; abdominal circumference: p = 0.32; femur length: p = 0.32). No differences in gestational age at delivery, birthweight, and in the incidence of low birthweight and small for gestational age newborns were observed between the two groups. In the multiple sclerosis group a significantly higher incidence of caesarean section (p = 0.01) and late preterm delivery (at less than 37 weeks\'gestation, p = 0.001) were registered. The trends of postnatal growth in weight (F = 0.53; p-value = 0.590) and length (F = 0.44; p-value = 0.645) were superimposable between the two groups. The trends of growth for head circumference showed a slightly, not significantly greater head circumference of infants from mothers with multiple sclerosis at 6 months of life, but the values at twelve months of life in the two groups were similar (F = 0.85; p-value = 0.427) . Moreover, the trends of postnatal increase of weight (F = 1.016; p-value = 0.331), length (F = 2.001; p-value = 0.146) and head circumference (F = 1.591; p-value = 0.212) of newborns/infants (from birth to twelve months of life) born to mothers with multiple sclerosis who breastfed, mothers who did not, and in the control group were similar.
CONCLUSIONS: Multiple sclerosis in pregnancy does not seem to affect fetal growth and postnatal development during the first year of the offspring life. We think that these results represent an important and reassuring information to provide the patients with during preconception counseling.