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Andrew Smith Thesis.2.pdf (1.73 MB)

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Pregnancy and Multiple Sclerosis: Risk of Unplanned Pregnancy, Drug Exposure In Utero, Relapse while Attempting Conception, and Post-Partum Relapse by Anesthesia Choice

Smith, Andrew Lawrence
http://rave.ohiolink.edu/etdc/view?acc_num=case1498749393114796

Abstract Details

2017, Master of Sciences, Case Western Reserve University, Clinical Research.
Background; Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease of the central nervous system that commonly affects young women of reproductive potential. As such, issues related to family planning are of critical importance. Objective; The objective of this study was to first determine both what are the risk factors of having an unplanned pregnancy and the risk factors of having a relapse while attempting to conceive. Secondly, we look at the rate of post-partum relapses as a function of labor anesthesia choice. Methods; A retrospective observational cohort study was created from a chart review. Multiple stepwise logistic regressions were used to determine the risk factors for a relapse while attempting, unplanned pregnancies, and DMT exposed pregnancies. Cox modeling was used to predict post-partum relapse Results; 150 patients were identified as having MS and concomitant pregnancy. The medical records of these patients were reviewed and 45 patients had both obstetric and MS care within the Cleveland Clinic hospital system. There were a total of 63 pregnancies (20 unplanned and 43 planned). Risk factors for unplanned pregnancy were younger age (p < 0.01), being on DMT (p < 0.001), and being unmarried (p < 0.001). Among those with planned pregnancies, the risk of relapse was dependent only on the time it took to conceive (p < 0.001). Of the total 63 deliveries, there were no significant differences in the number of post-partum relapses or time to relapse among the different anesthesia modality groups (p = 0.71). Conclusion; The rate of unplanned pregnancies is lower than previous though. Intervention at younger unmarried patient may lead to reduce rate of unplanned and DMT exposed pregnancies. MS patients should be referred to reproductive medicine sooner to avoid return of disease activity. Finally, MS should not affect anesthesia used during delivery.
Daniel Ontaneda (Advisor)
59 p.
Neurology
Multiple Sclerosis, Pregnancy, Anesthesia, Relapsing remitting

Recommended Citations

Citations

  • Smith, A. L. (2017). Pregnancy and Multiple Sclerosis: Risk of Unplanned Pregnancy, Drug Exposure In Utero, Relapse while Attempting Conception, and Post-Partum Relapse by Anesthesia Choice [Master's thesis, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1498749393114796

    APA Style (7th edition)

  • Smith, Andrew. Pregnancy and Multiple Sclerosis: Risk of Unplanned Pregnancy, Drug Exposure In Utero, Relapse while Attempting Conception, and Post-Partum Relapse by Anesthesia Choice . 2017. Case Western Reserve University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1498749393114796.

    MLA Style (8th edition)

  • Smith, Andrew. "Pregnancy and Multiple Sclerosis: Risk of Unplanned Pregnancy, Drug Exposure In Utero, Relapse while Attempting Conception, and Post-Partum Relapse by Anesthesia Choice ." Master's thesis, Case Western Reserve University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1498749393114796

    Chicago Manual of Style (17th edition)

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© 2017, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.