Table.
Cohort Characteristics of Pregnancies Resulting in Live Births
| Preconception DMT | ||||||||
| OCR (n = 73) | RTX (n = 24) | NAT (n = 419) | NAT-A (n = 82)a | NAT-C (n = 82)a | DMF (n = 164) | Low (n = 1,329) | p b | |
| Pregnancy duration, median (IQR), weeks | 39.0 (38.0–40.0) | 38.1 (36.7–38.8) | 38.7 (36.7–40.0) | 38.9 (37.6–39.8) | 38.0 (35.5–39.1) | 39.0 (37.6–40.0) | 39.0 (37.3–40.0) | 0.052 |
| Age at start of pregnancy, median (IQR), y | 33.8 (30.7–37.3) | 33.3 (29.1–35.0) | 31.5 (28.6–34.4) | 32.5 (28.5–35.3) | 31.9 (29.4–34.0) | 31.4 (28.4–34.2) | 31.5 (28.2–34.6) | 0.005 |
| Time from first symptoms to start of pregnancy, median (IQR), y | 7.10 (3.90–10.5) | 6.16 (4.24–9.96) | 7.41 (4.21–11.7) | 7.59 (4.01–11.9) | 8.59 (5.27–12.6) | 5.70 (2.96–9.18) | 5.83 (3.25–9.51) | <0.001 |
| DMT used before, median (IQR), n | 1 (0,2) | 1 (0,2) | 1 (1,2) | 1 (0,2) | 2 (1,2) | 1 (0,2) | 0 (0,1) | <0.001 |
| EDSS score at start of pregnancy, n (%)c | <0.001 | |||||||
| <2 | 25 (34.2) | 12 (50) | 198 (47.3) | 39 (47.6) | 41 (50.0) | 95 (57.9) | 674 (50.8) | |
| ≥2 | 28 (38.4) | 7 (29.2) | 122 (29.1) | 21 (25.6) | 24 (29.3) | 28 (17.1) | 213 (16.0) | |
| Missing | 20 (27.4) | 5 (20.8) | 99 (23.6) | 22 (26.8) | 17 (20.7) | 41 (25.0) | 441 (33.2) | |
| EDSS score at start of pregnancy, median (IQR)c | 2 (1,2.5) | 1.5 (0.5–2) | 1.5 (1,2) | 1 (0,2) | 1.5 (1,2) | 1 (1,1.5) | 1 (0,1.5) | <0.001 |
| Range | 0,5 | 0,6 | 0,6 | 0,3 | 0,6 | 0,6 | 0,6.5 | |
| ARR in 1 y before pregnancy, mean (SD) | 0.14 (0.53) | 0.13 (0.45) | 0.11 (0.48) | 0.05 (0.25) | 0.11 (0.38) | 0.20 (1.06) | 0.24 (0.72) | <0.001 |
| DMT prepregnancy duration, median (IQR), mo | 9.95 (5.82–18.1) | 16.7 (9.27–24.8) | 18.1 (9.10–32.0) | 24.8 (9.91–38.2) | 16.0 (6.22–30.4) | 14.1 (8.07–24.8) | 23.5 (10.7–44.8) | <0.001 |
| DMT washout, median (IQR), mo | 1.87 (0–4.76) | 3.43 (0.74–5.03)d | 0 (0–0) | — | — | 0 (0–1.32) | 0 (0–0.821) | <0.001 |
| DMT duration into pregnancy, median (IQR), mo | 0 (0–0.460) | 0 (0–0)d | 0.89 (0–6.42) | — | — | 0.21 (0–1.13) | 0.49 (0–1.35) | <0.001 |
| DMT initiated after delivery, n (%)e | ||||||||
| Ocrelizumab | 43 (58.9) | 1 (4.2) | 12 (2.9) | 0 | 0 | 2 (1.2) | 1 (0.1) | |
| Natalizumab | 2 (2.7) | 0 | 304 (72.6) | 82 (100) | 82 (100) | 6 (3.7) | 18 (1.4) | |
| Dimethyl fumarate | 0 | 0 | 3 (0.7) | 0 | 0 | 76 (46.3) | 25 (1.9) | |
| Lowf | 1 (1.4) | 1 (4.2) | 9 (2.1) | 0 | 0 | 9 (5.5) | 719 (54.1) | |
| Sphingosine-1-phosphate modulatorg | 1 (1.4) | 0 | 14 (3.3) | 0 | 0 | 4 (2.4) | 38 (2.9) | |
| Rituximab | 0 | 18 (75) | 2 (0.5) | 0 | 0 | 0 | 1 (0.1) | |
| Ofatumumab | 2 (2.7) | 1 (4.2) | 1 (0.2) | 0 | 0 | 1 (0.6) | 0 | |
| Alemtuzumab | 0 | 0 | 9 (2.1) | 0 | 0 | 0 | 1 (0.1) | |
| Cladribine | 0 | 0 | 3 (0.7) | 0 | 0 | 0 | 1 (0.1) | |
| None | 24 (32.9) | 3 (12.5) | 62 (14.8) | 0 | 0 | 66 (40.2) | 525 (39.5) | |
| Time to DMT initiation after delivery, median (IQR), moh | 1.41 (0.49–3.02) | 1.63 (0.77–1.91)d | 0.89 (0.10–2.30) | — | — | 2.25 (0.49–4.39) | 2.43 (0.44–5.03) | <0.001 |
Abbreviations: ARR = annualized relapse rate; DMF = dimethyl fumarate; DMT = disease-modifying therapy; EDSS = Expanded Disability Status Scale; IQR = interquartile range; NAT = natalizumab; OCR = ocrelizumab, RTX = rituximab.
NAT-A (active natalizumab strategy of continuation to ≥28 weeks of gestation and reinitiation within 1 month after delivery) and NAT-C (conservative strategy of cessation ≤4 weeks of gestation and reinitiation more than 1 month after delivery) were subset from the overall natalizumab (NAT) cohort.
Comparisons were between OCR, RTX, NAT, DMF, and low-efficacy DMT groups.
Calculated from women with available EDSS scores closest to start of pregnancy (within 1 year).
Data available for 16 of 24 women in the RTX cohort.
In the 6-mo postpartum period.
Low-efficacy DMT initiated in the postpartum period include interferon-beta, glatiramer acetate, teriflunomide, azathioprine, and mycophenolate.
Sphingosine-1-phosphate modulators include fingolimod and siponimod.
Women who initiated either preconception DMT or other DMTs.