Exposición a fármacos modificadores de la enfermedad durante el embarazo en esclerosis múltiple: estudio prospectivo

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.