Effect of neuraxial anaesthesia or analgesia on postpartum relapse rates in multiple sclerosis: A systematic review.

Abstract

Background: Multiple sclerosis (MS) is a chronic autoimmune disease affecting primarily women of childbearing age. Recent advancements in treatment have led to more women with MS pursuing motherhood. Despite much new evidence on the safety of neuraxial anaesthesia/analgesia, many anaesthetists are still reluctant to provide neuraxial anaesthesia/analgesia to these patients.

Objective: The present systematic review aimed to evaluate the safety of administrating neuraxial anaesthesia/analgesia to parturients with MS.

Outcome: The incidence of MS relapses occurring up to 1 year after childbirth was the main outcome of interest.

Design: A systematic review of randomised and non-randomised controlled trials.

Data sources: MEDLINE (PubMed), Library of Congress and LiSTA (EBSCO) were searched to identify eligible trials.

Eligibility criteria: Randomised or nonrandomised prospective studies and retrospective comparative studies, comparing MS relapses following caesarean section or vaginal delivery were included.

Results: Eight studies involving 1315 parturients were included. There was no statistically significant difference in the incidence of postpartum relapses between women who received neuraxial anaesthesia/analgesia and those who did not ( P  > 0.05). A statistically significant increase in the probability of a relapse was consistently observed across the majority of studies in women who had experienced relapses during pregnancy or during the year preceding the pregnancy ( P  < 0.05).

Conclusion: Neuraxial analgesia/anaesthesia does not increase the risk of postpartum relapse in MS parturients in the year following delivery. The risk of postpartum relapse is related to symptom exacerbation during the year before pregnancy or during pregnancy. Adequately powered, prospective, studies are strongly recommended to confirm the above results.