Sars-CoV2 infection in pregnant women with multiple sclerosis

Background: In the general population, maternal SARS-CoV-2 infection during pregnancy is associated with worse maternal outcomes; however, only one study so far has evaluated COVID-19 clinical outcomes in pregnant and postpartum women with multiple sclerosis, showing no higher risk for poor COVID-19 outcomes in these patients. Objective: In this multicenter study, we aimed to evaluate COVID-19 clinical outcomes in pregnant patients with multiple sclerosis. Methods: We recruited 85 pregnant patients with multiple sclerosis who contracted COVID-19 after conception and were prospectively followed-up in Italian and Turkish Centers, in the period 2020-2022. A control group of 1354 women was extracted from the database of the Multiple Sclerosis and COVID-19 (MuSC-19). Univariate and subsequent logistic regression models were fitted to search for risk factors associated with severe COVID-19 course (at least one outcome among hospitalization, intensive care unit [ICU] admission and death). Results: In the multivariable analysis, independent predictors of severe COVID-19 were age, body mass index ⩾ 30, treatment with anti-CD20 and recent use of methylprednisolone. Vaccination before infection was a protective factor. Vaccination before infection was a protective factor. Pregnancy was not a risk nor a protective factor for severe COVID-19 course. Conclusion: Our data show no significant increase of severe COVID-19 outcomes in patients with multiple sclerosis who contracted the infection during pregnancy.

[1]  F. Piehl,et al.  COVID‐19 clinical outcomes and DMT of MS patients and population‐based controls , 2022, Annals of clinical and translational neurology.

[2]  G. Cutter,et al.  COVID-19 in the pregnant or postpartum MS patient: Symptoms and outcomes , 2022, Multiple Sclerosis and Related Disorders.

[3]  M. Sahraian,et al.  Association between disease-modifying therapies and adverse clinical outcomes in multiple sclerosis patients with COVID-19 infection , 2022, Multiple Sclerosis and Related Disorders.

[4]  Joshua I. Rosenbloom,et al.  Safety of SARS-CoV-2 vaccination during pregnancy- obstetric outcomes from a large cohort study , 2022, BMC Pregnancy and Childbirth.

[5]  G. Saade,et al.  Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications. , 2022, JAMA.

[6]  F. Lund-Johansen,et al.  Immunogenicity and Safety of a Third SARS-CoV-2 Vaccine Dose in Patients With Multiple Sclerosis and Weak Immune Response After COVID-19 Vaccination , 2022, JAMA neurology.

[7]  I. Weerasekara,et al.  Adverse Perinatal Outcomes in COVID-19 Infected Pregnant Women: A Systematic Review and Meta-Analysis , 2022, Healthcare.

[8]  D. Adam.  The pandemic’s true death toll: millions more than official counts , 2022, Nature.

[9]  T. Wainstock,et al.  Prenatal maternal COVID-19 vaccination and pregnancy outcomes , 2021, Vaccine.

[10]  S. Rasmussen,et al.  An update on COVID-19 and pregnancy , 2021, American Journal of Obstetrics and Gynecology.

[11]  L. Magee,et al.  COVID-19 vaccination during pregnancy: coverage and safety , 2021, American Journal of Obstetrics and Gynecology.

[12]  M. Wick,et al.  Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy , 2021, American Journal of Obstetrics & Gynecology MFM.

[13]  Jean Y. Ko,et al.  Adverse pregnancy outcomes, maternal complications, and severe illness among U.S. delivery hospitalizations with and without a COVID-19 diagnosis , 2021, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  J. Ludvigsson,et al.  Association of Maternal SARS-CoV-2 Infection in Pregnancy With Neonatal Outcomes. , 2021, JAMA.

[15]  C. Olson,et al.  Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons , 2021, The New England journal of medicine.

[16]  G. Cutter,et al.  Outcomes and Risk Factors Associated With SARS-CoV-2 Infection in a North American Registry of Patients With Multiple Sclerosis , 2021, JAMA neurology.

[17]  M. Sormani,et al.  Disease‐Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis , 2021, Annals of neurology.

[18]  M. Sadarangani,et al.  Maternal Immunological Adaptation During Normal Pregnancy , 2020, Frontiers in Immunology.

[19]  R. Reynolds,et al.  Pregnancy and COVID-19 , 2020, Physiological reviews.

[20]  V. Jokubaitis,et al.  MS, pregnancy and COVID-19 , 2020, Multiple sclerosis.

[21]  S. Gilboa,et al.  Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[22]  P. Brocklehurst,et al.  Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study , 2020, BMJ.

[23]  J. Illuzzi,et al.  Prevalence of SARS-CoV-2 Among Patients Admitted for Childbirth in Southern Connecticut. , 2020, JAMA.

[24]  A. Carnahan,et al.  Pregnant and postpartum women with SARS-CoV-2 infection in intensive care in Sweden. , 2020, Acta obstetricia et gynecologica Scandinavica.

[25]  W. Yoong,et al.  Re: Novel Coronavirus COVID-19 in late pregnancy: Outcomes of first nine cases in an inner city London hospital , 2020, European Journal of Obstetrics & Gynecology and Reproductive Biology.

[26]  Dena Goffman,et al.  Universal Screening for SARS-CoV-2 in Women Admitted for Delivery , 2020, The New England journal of medicine.

[27]  J. Lechner-Scott,et al.  Incidence of pregnancy and disease-modifying therapy exposure trends in women with multiple sclerosis: A contemporary cohort study. , 2019, Multiple sclerosis and related disorders.

[28]  M. Filippi,et al.  Multiple sclerosis , 2018, Nature Reviews Disease Primers.

[29]  M. Houtchens,et al.  Pregnancy rates and outcomes in women with and without MS in the United States , 2018, Neurology.

[30]  David H. Miller,et al.  Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria , 2017, The Lancet Neurology.

[31]  Jeffrey A. Cohen,et al.  Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria , 2011, Annals of neurology.

[32]  S. Reingold,et al.  Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria” , 2005, Annals of neurology.

[33]  A. Compston,et al.  Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis , 2001, Annals of neurology.

[34]  S. Konichezky,et al.  Acute respiratory failure in pregnancy , 1998, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[35]  J. Kurtzke.  Rating neurologic impairment in multiple sclerosis , 1983, Neurology.

[36]  F. Nuttall.  Body Mass Index , 2015, Nutrition today.