Perinatal outcomes in multiple sclerosis

Multiple sclerosis (MS) is a putative autoimmune disease of the central nervous system, affecting many adults of childbearing age. Although extensive research has examined the association between MS and traditional perinatal outcomes (i.e. cesarean section, birth weight and preterm birth), other important outcomes are understudied, partly due to existing methodological challenges. Using comprehensive populationbased databases including the British Columbia (BC) MS Database, BC Perinatal Database Registry, Vital Statistics Birth Registry, Population Data BC Consolidation File and Census GeoData, this dissertation investigated the association between MS (and related clinical factors) with: labour induction and augmentation; obstetrical epidural and spinal anesthesia; length of birth hospitalization in mothers and their newborns; as well as birth outcomes in fathers with MS. Overall, individuals with MS were not at increased risk for the investigated outcomes compared to the general population with the exception that multiparous women with MS had higher rates of epidural anesthesia compared to multiparous women in the general population. Within MS women, those with longer disease duration had less epidural anesthesia and those with greater disability had more labor induction. Men with greater MS disability tended to father offspring with lower mean birth weight, but their newborns were still within the normal range for the general population. Individuals with MS who wish to have children must also decide between initiating disease-modifying drug (DMD) early to minimize relapses (i.e. MS attacks) or delaying/stopping therapy prior to conception to avoid potential fetal harm from in utero DMD exposure. This dissertation explored perinatal outcomes in women and men with iii MS exposed to DMDs and includes a systematic review of DMD exposure on perinatal outcomes. Data from BC suggest that DMD exposure in men and women with MS does not increase the risk of unfavorable perinatal outcomes. However, best evidence from the systematic review indicates that interferon-beta exposure in women with MS is associated with preterm birth, lower mean birth weight and shorter mean birth length in newborns; nonetheless, growth parameters of exposed newborns remained within normal values for the general population and preterm births tended to be close to term.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat