Postpartum administration of intravenous (IV) steroids significantly reduced the incidence of relapses in women with MS in a study conducted at the Baylor College of Medicine in Houston, Texas. Of the 52 patients in the study, 39 received postpartum IV steroids (methylprednisolone, 1 g), and 13 did not. During the first postpartum trimester, 18 percent of women who received IV steroids experienced relapses. The frequency of relapse was about 46 percent in those who did not receive steroids. In the second and third postpartum trimesters, relapse percentage was about 26 percent among patients who received steroids and 23 percent in those who did not.
The retrospective analysis included 50 women with relapsing-remitting MS and two with secondary progressive MS who had experienced one or more pregnancies. Each pregnancy was considered an individual case. Examined data included MS type; number of relapses before, during, and after pregnancy (first, second, and third trimester postpartum); treatment history; breastfeeding duration; and postpartum IV steroid use.Seven patients had at least 1 relapse during pregnancy.
Because MS is prevalent in young women, MS issues related to pregnancy are of concern, says Jose Avila, M.D., a neurologist and a postdoctoral fellow in MS at the Baylor College of Medicine, Houston, Texas. While pregnancy exerts a protective effect against relapses, they do increase in frequency during the postpartum period. According to the researchers who presented the study at the Consortium of Multiple Sclerosis Centers 24th Annual Conference, the mean relapse rate during the first trimester after delivery approximately doubles during the first trimester of pregnancy.
"Other centers have done this using intravenous immunoglobulin, but it is more expensive and has other side effects," Dr. Avila, who presented the research at a poster session, told Medscape Neurology. "Our suggestion is to give 1 g methylprednisolone right after delivery," he added.
"This opens the door to the validity of giving methylprednisolone postpartum. The next question is, should we give it every month during the first 3 months? I think we're also going to see people looking at giving IV immunoglobulin immediately postpartum," James P. Simsarian, M.D., director of the Multiple Sclerosis Program at the Neurology Center of Fairfax, Virginia, told Medscape Neurology. "[Postpartum treatment of MS patients] is something everyone should do, and eventually there will be protocols," Dr. Simsarian added.