MS Pregnancy – Relapse Risk Pattern — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS Pregnancy – Relapse Risk PatternSCE Neurology

A 35-year-old woman with MS asks about the risk of relapse during pregnancy and the postpartum period. What does the evidence show?

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Correct answer: E — Relapse risk decreases during pregnancy (especially in the third trimester) but increases in the first 3 months postpartum — this is attributed to the immunomodulatory effects of pregnancy hormones

The PRIMS study and subsequent data show that MS relapse rate decreases by ~70% during the third trimester (due to pregnancy-associated immunomodulation — increased regulatory T cells, shift from Th1 to Th2, oestrogen/progesterone effects) but increases by ~70% in the first 3 months postpartum (as the immune system returns to its pre-pregnancy state). Pre-pregnancy disease activity is the strongest predictor of postpartum relapse. Some DMTs can be restarted relatively quickly after delivery to reduce postpartum relapse risk. Exclusive breastfeeding may provide some protective effect (Confavreux data). A: Risk decreases during pregnancy. C: Significant effect. D: Third trimester has the lowest risk. E: Breastfeeding may provide modest protection but does not guarantee prevention.

Reference: NICE NG100 MS; PRIMS Study (Confavreux et al., NEJM 1998)