Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

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Lavie, Caroline | Rollot, Fabien | Durand-Dubief, Françoise | Marignier, Romain | Ionescu, Iuliana | Casey, Romain | Moreau, Thibault | Tourniaire, Patricia | Hutchinson, Michael | D’hooghe, Marie Béatrice | Laplaud, David-Axel | Clavelou, Pierre | de Sèze, Jérôme | Debouverie, Marc | Brassat, David | Pelletier, Jean | Lebrun-Frenay, Christine | Le Page, Emmanuelle | Castelnovo, Giovanni | Berger, Eric | Hautecoeur, Patrick | Heinzlef, Olivier | Durelli, Luca | Clerico, Marinella | Trojano, Maria | Patti, Francesco | Vukusic, Sandra | Alpérovitch, A. | Carton, H. | Hommes, O. | Adeleine, P. | Biron, A. | Grimaud, J. | Hours, M. | Latombe, D. | Clanet, M. | Lau, G. | Rumbach, L. | Goas, J. | Rouhart, F. | Mazingue, A. | Roullet, E. | Madigand, M. | Brunet, P. | Allaire, C. | Riffault, G. | Leche, J. | Benoit, T. | Simonin, C. | Ziegler, F. | Baron, J. | Rivrain, Y. | Dumas, R. | Loche, D. | Bourrin, J. | Huttin, B. | Delisse, B. | Gibert, I. | Boulay, C. | Verceletto, M. | Durand, Geoffroy | Bonneviot, G. | Gil, R. | Hedreville, A. | Belair, C. | Poitevin, J. | Devoize, J. | Wyremblewski, P. | Delestre, F. | Setiey, A. | Comi, G. | Filippi, M. | Ghezzi, A. | Martinelli, V. | Rossi, P. | Tola, M. | Amato, M. | Fioretti, C. | Meucci, G. | Inglese, M. | Mancardi, G. | Gambi, D. | Thomas, A. | Cavazzuti, M. | Citterio, A. | Heltberg, A. | Hansen, H. | Fernandez, O. | Romero, F. | Arbizu, T. | Hernández, J. | de Andres de Frutos, C. | Geffner Sclarky, D. | Aladro Benito, Y. | Reyes Yanes, P. | Aguilar, M | Burguera, A. | Yaya, R. | Bonakim Dib, W. | Arzua-Mouronte, D. | D’hooghe, M.B. | Sindic, M. | Medaer, R. | Roose, H. | Geens, M. | Guillaume, D. | van Zandycke, M. | Janssens, J. | Cornette, M. | Mol, L. | Weilbach, F. | Flachenecker, P. | Haas, J. | Tendolkar, I. | Sindrn, E. | Kölmel, H. | Reichel, D. | Rauch, M. | Preuss, S. | Poser, S. | Mauch, E. | Strausser-Fuchs, S. | Kolleger, H. | Hawkins, S. | Howell, J. | Rees, J. | Thompson, A. | Johnson, M. | Boggild, M. | Gregory, P. | Bates, D. | Bone, I. | Polman, C. | Frequin, S. | Jongen, P. | Correia de Sa, J. | Rio, M. | Huber, S. | Lechner-Scott, J. | Kappos, Ludwig | Baulieu, E. | El-Etr, M. | Schumacher, M. | Confavreux, C. | Cornu, C. | Hartung, H. | Miller, H. | Pugeat, M. | D’archangues, C. | Conard, J. | Ménard, J. | Sitruk-Ware, R. | Pélissier, C. | Dat, S. | Belaïsch-Allard, J. | Athéa, N. | Büschsenschutz, D. | Lyon-Caen, O. | Gonsette, R. | Boissel, P. | Ffrench, P. | Cotton, F. | Pachai, C. | Bracoud, L. | Vukusic, S. | Androdias, G. | Chauplannaz, G. | Laplaud, A. | Wiertlewski, S. | Lanctin-Garcia, C. | Couvreur, G. | Madinier, G. | Taithe, F. | Aufauvre, D. | Guy, N. | Ferrier, A. | Collongues, N. | Viala, F. | Gerdelat-Mas, A. | Henry, P. | Rico-Lamy, A. | Lepage, E. | Deburghraeve, V. | Edan, Gilles | Blondiau, M. | Coustans, M. | Clerc, C. | Rieu, L. | Lau, M. | Hinzelin, G. | Ouallet, J. | Minier, D. | Vion, P. | Gromaire-Fayolle, N. | Derache, N. | Thouvenot, Eric | Sallansonnet-Froment, M. | Toureille, L. | Borgel, F. | Stankoff, Bruno | Moroianu, C. | Guennoc, A. | Tournier-Gervason, C. | Peysson, S. | D’amico, E. | Motti, L. | Zaffaroni, M. | Tavella, A.

Edité par HAL CCSD ; SAGE Publications

International audience. Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses.Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy.Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992-1995 and 2005-2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis.Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78).Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

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