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Researchers say pain treatment during labour does not increase risk of MS relapses after giving birth

A certain type of pain-relief given during childbirth does not increase the risk of women with multiple sclerosis (MS) having relapses after giving birth, a European study reports. The study titled “Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS” appeared in the Multiple Sclerosis Journal and studied treatments known as neuraxial analgesia.

Recent research has shown that the rate of relapses decreases during pregnancy, especially in the final three months, but that relapses can increase in the first three months after giving birth. This is particularly true in women who have had relapses in the year before pregnancy, or while pregnant.

A current debate among doctors is therefore whether local anaesthetics that decrease pain during labour, or when giving birth actually trigger MS relapses by acting on MS affected nerve fibres. As a result many anaesthetists do not want to give neuraxial analgesia treatments to women who have had recent relapses.

To try to shed light on this dilemma, European researchers looked at whether neuraxial analgesia increased the risk of women with MS having relapses in the first three months after giving birth. They recruited women with mild MS disability who were not taking disease-modifying treatments during pregnancy, or in the three months after giving birth. The researchers found women who had a relapse during pregnancy were more likely to have a post-delivery relapse, regardless of whether they received a neuraxial analgesia.

The researchers also analysed two large European studies - The PRIMS trial involving 215 women and The POPART’MUS trial involving 174 women – a total of 389 women. In these two earlier studies 156 out of the 389 women, or 40%, were given neuraxial analgesia. Twenty-four per cent had relapses during pregnancy and 25% in the three months after giving birth.

Matching these earlier findings to their own study the researchers concluded that women who had a relapse during pregnancy were more likely to have a relapse after giving birth, regardless of whether they received neuraxial analgesia. The researchers did not therefore find a link between neuraxial analgesia and post-delivery relapse, a finding in line with results of the earlier studies.

Source: MS-UK 09/04/18

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