Exposición a fármacos modificadores de la enfermedad durante el embarazo en esclerosis múltiple: estudio prospectivo / Pregnancy exposure to disease-modifying drugs in multiple sclerosis: a prospective study

RESUMEN

INTRODUCCIÓN: En esclerosis múltiple (EM), la exposición fetal a fármacos modificadores de la enfermedad (FME) conlleva distintos grados de riesgo. OBJETIVO: analizar nuestra experiencia en relación con los casos de exposición fetal involuntaria a FME. PACIENTES Y MÉTODOS: Estudio observacional. Se analizaron los datos clínico-obstétricos de una cohorte de pacientes con EM, entre 2007 y 2017. Grupo EM pacientes con EM con embarazos expuestos a FME. Grupo control pacientes con EM no expuestas y embarazadas sanas. RESULTADOS: Hubo un total de 68 embarazos en pacientes con EM. Control 56 mujeres sanas. Grupo EM expuestas a FME durante embarazo 13; bajo peso al nacer 2(15%); parto pretérmino 0. Grupo EM no expuestas a FME 55; 22 (40%) suspendieron FME previo embarazo; 33 (60%) naïve; bajo peso al nacer 5 (9%); pretérmino 7 (12%). Grupo mujeres sanas bajo peso al nacer, 6 (11%); parto pretérmino, 6 (11%). No hubo diferencias clínicas estadísticamente significativas entre pacientes EM. Tampoco hubo diferencias en peso al nacer, tiempo de gestación o morbilidad obstétrica en expuestas a FME. CONCLUSIONES: No hubo diferencias clínicas estadísticamente significativas, ni mayor morbilidad obstétrica, entre pacientes expuestas a FME, no expuestas y embarazadas sanas

ABSTRACT

INTRODUCTION: In multiple sclerosis (MS), foetal exposure to disease-modifying drugs (DMDs) carries varying degrees of risk. We sought to analyse the clinical and obstetric outcomes of MS patients (MSp) exposed to DMDs during pregnancy. PATIENTS AND METHODS: Observational study. We analysed the clinical-obstetric data of a cohort MSp, who became pregnant between 2007-2017. They were prospectively followed up during pregnancy and postpartum. CONTROL GROUP healthy pregnant women (HPW) and MSp unexposed to DMDs. RESULTS: Sixty-eight pregnancies in MSp. Fifty-six HPW. Thirteen MSp were exposed to DMDs during pregnancy. Obstetric outcome: 2 (15%) infants had low birth weight, no preterm deliveries. Fifty-five MSp were not exposed to DMDs 22 (40%) discontinued DMD before pregnancy, 33(60%) naïve. Five infants (9%) had low birth weight and 7 (12%) were preterm. HPW 56. Low birth weight 6 (11%), preterm delivery 6 (11%). There were no differences in relapse incidence during pregnancy-puerperium between MSp groups. There were no differences in birth weight, gestation time, delivery-caesarean section. We found no special obstetric morbidity in women exposed to DMDs. CONCLUSIONS: There were no significant differences in the clinical and obstetric variables analysed between pregnant women exposed to DMDs, unexposed, and HPW