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Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Caroline Lavie 1 Fabien Rollot 2 Françoise Durand-Dubief 3 Romain Marignier 3, 4 Iuliana Ionescu 3 Romain Casey 2 Thibault Moreau 5 Patricia Tourniaire 6 Michael Hutchinson 7, 8 Marie Béatrice D’hooghe 9, 7 David-Axel Laplaud 10 Pierre Clavelou 11, 12 Jérôme de Sèze 13, 14 Marc Debouverie 15, 16 David Brassat 17, 18 Jean Pelletier 19, 20 Christine Lebrun-Frenay 21, 22 Emmanuelle Le Page 23 Giovanni Castelnovo 24 Eric Berger 25 Patrick Hautecoeur 26 Olivier Heinzlef 27 Luca Durelli 28 Marinella Clerico 28 Maria Trojano 28 Francesco Patti 29 Sandra Vukusic 30, 2, 4, * A. Alpérovitch H. Carton O. Hommes P. Adeleine 31 A. Biron J. Grimaud M. Hours D. Latombe M. Clanet 32 G. Lau L. Rumbach J. Goas F. Rouhart A. Mazingue E. Roullet M. Madigand P. Brunet C. Allaire G. Riffault J. Leche T. Benoit C. Simonin F. Ziegler J. Baron Y. Rivrain R. Dumas D. Loche J. Bourrin B. Huttin B. Delisse I. Gibert C. Boulay 33 M. Verceletto Geoffroy Durand 34 G. Bonneviot R. Gil A. Hedreville C. Belair J. Poitevin J. Devoize P. Wyremblewski F. Delestre A. Setiey G. Comi 19 M. Filippi 19 A. Ghezzi V. Martinelli P. Rossi M. Tola M. Amato C. Fioretti G. Meucci M. Inglese G. Mancardi D. Gambi A. Thomas 35 M. Cavazzuti A. Citterio 36 A. Heltberg H. Hansen O. Fernandez F. Romero T. Arbizu J. Hernández 37 C. de Andres de Frutos D. Geffner Sclarky Y. Aladro Benito P. Reyes Yanes M Aguilar A. Burguera R. Yaya W. Bonakim Dib D. Arzua-Mouronte M.B. D’hooghe M. Sindic R. Medaer H. Roose M. Geens D. Guillaume 38 M. van Zandycke J. Janssens M. Cornette L. Mol F. Weilbach P. Flachenecker J. Haas I. Tendolkar E. Sindrn H. Kölmel D. Reichel M. Rauch S. Preuss 39 S. Poser E. Mauch S. Strausser-Fuchs H. Kolleger S. Hawkins J. Howell J. Rees A. Thompson M. Johnson M. Boggild P. Gregory 40 D. Bates I. Bone C. Polman 19 S. Frequin P. Jongen J. Correia de Sa M. Rio 41 S. Huber J. Lechner-Scott Ludwig Kappos 19 E. Baulieu M. El-Etr 42 M. Schumacher 42 C. Confavreux 43 C. Cornu 44 H. Hartung H. Miller M. Pugeat C. D’archangues J. Conard J. Ménard R. Sitruk-Ware C. Pélissier 45 S. Dat J. Belaïsch-Allard N. Athéa D. Büschsenschutz O. Lyon-Caen R. Gonsette P. Boissel 46 P. Ffrench F. Cotton 47 C. Pachai 43 L. Bracoud S. Vukusic 48, * G. Androdias G. Chauplannaz A. Laplaud S. Wiertlewski 10 C. Lanctin-Garcia G. Couvreur G. Madinier F. Taithe 49 D. Aufauvre N. Guy A. Ferrier 50 N. Collongues 51 F. Viala 52 A. Gerdelat-Mas P. Henry A. Rico-Lamy E. Lepage 19 V. Deburghraeve Gilles Edan 53 M. Blondiau M. Coustans 54 C. Clerc L. Rieu M. Lau G. Hinzelin J. Ouallet D. Minier P. Vion N. Gromaire-Fayolle N. Derache Eric Thouvenot 24 M. Sallansonnet-Froment L. Toureille F. Borgel Bruno Stankoff 55 C. Moroianu A. Guennoc C. Tournier-Gervason S. Peysson E. D’amico L. Motti M. Zaffaroni A. Tavella
* Corresponding author
31 Biostatistiques santé
Département biostatistiques et modélisation pour la santé et l'environnement [LBBE]
47 RMN et optique : De la mesure au biomarqueur
CREATIS - Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé
52 LRSI - Laboratoire de Réactivité des Surfaces et des Interfaces
DPC - Département de Physico-Chimie : DEN/DPC
53 Empenn
INSERM - Institut National de la Santé et de la Recherche Médicale, Inria Rennes – Bretagne Atlantique , IRISA-D5 - SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE
Abstract : Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992-1995 and 2005-2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.
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Submitted on : Tuesday, June 18, 2019 - 12:05:27 PM
Last modification on : Monday, May 16, 2022 - 8:20:20 AM

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Caroline Lavie, Fabien Rollot, Françoise Durand-Dubief, Romain Marignier, Iuliana Ionescu, et al.. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS. Multiple Sclerosis Journal, SAGE Publications, 2019, 25 (4), pp.591-600. ⟨10.1177/1352458518763080⟩. ⟨hal-02158735⟩

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