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Saumya Gupta
(she/her)
BWH Job Title:
Research Assistant
Academic Rank:
N/A
Department/Division/Lab:
Neurology
Division: Multiple Sclerosis
Tanuja Chitnis Lab
Authors:
Saumya Gupta, MS, Preksha Kukreja, BS, Jeta Pol-Patil, MS, Maria Claudia Manieri, BA, Tatenda Mahlanza, BA, Eric C Klawiter, MD, Andrew J Solomon, MD, Ellen S Lathi, MD, Joshua Katz, MD, Carolina Ionete, MD, PhD, Idanis Berrios Morales, MD, Ann Cabot, DO, Christopher A Severson, MD, James M Stankiewicz, MD, Claudia Chaves, MD, Shamik Bhattacharyya, MD, Dorlan J Kimbrough, MD, Biljana Beretich, MD, Tanuja Chitnis, MD, Adele Dessa Sadovnick, PhD and Maria K Houtchens, MD
Recent studies suggest a high level of postpartum inflammatory MRI activity in Multiple Sclerosis (MS) patients. PREG-MS is a comprehensive longitudinal cohort study of pregnancy outcomes in MS patients. The registry recruited subjects between years 2017 and 2020, from across the New England states of the United States, and focused on obstetrical, neurologic, and pediatric outcomes. Here we describe new MRI activity and its predictors in the peripartum period in Women with MS (WwMS) from PREG-MS cohort.
135 WwMS were followed from conception attempts up to 3 years post-partum. 118 pregnancies occurred during the study period. 95 women underwent MRI scans pre- and postpartum. Pre-partum MRIs were (25.3 weeks +/- 21.2) before delivery and post-partum MRIs were (13.6 weeks +/-11.5) after delivery. “New MRI activity” was defined as new T2 or Gadolinium (Gd+) enhancing lesions on brain or spinal cord MRI. Proportion of subjects with active MRIs and relapse rate (RR) were compared before, during and after pregnancy.
Out of the 95 MRI scans performed, 23 women (29%) had new brain activity on preconception scans, including 9 (11.4%) with Gd+ lesions. 22 women (27.8%) had new brain lesions in their postpartum scan, including 5.1% with Gd+ lesions. 15 WwMS (15.8%) had both pre-conception and post-conception brain activity. New postpartum MRI activity was not associated with new overall preconception MRI activity (OR=1.9, p>0.05), preconception or postpartum relapses, advanced maternal age, no evidence of disease activity (NEDA) status, or breastfeeding status postpartum (p>0.05.)
New postpartum MRI activity was associated with new preconception Gd+ lesions, no use of disease modifying treatment (DMT) prepartum, intrapartum relapses, and no use of disease modifying treatment (DMT) post-partum (p< 0.05,) and it was also highly associated with intrapartum relapses (p0.05).
24 patients (30.4%) were off DMT at the time of preconception MRI and 20 patients (25.3%) were off DMT at the time of postpartum MRI. There was no correlation between length of DMT washout period and postpartum MRI activity (p>0.05). Not being on DMT before pregnancy correlated with preconception brain MRI activity (OR = 1.02, p<0.001).
During the study period, 45 unique WwMS (47.4%) had new inflammatory brain or spine MRI changes, significantly exceeding observed clinical relapses (38.9%) of clinical relapses).
MRI remains a sensitive tool to monitor peri-partum inflammatory activity in WwMS. Significant number of WwMS experienced either clinical, MRI, or combined MS activity in the peri-partum period. Our findings underscore the need for individualized treatment strategies and close MRI monitoring of WwMS throughout their pregnancy journey to optimize neurological disease outcomes.
