Pregnancy Outcomes in Women with Multiple Sclerosis Who Had Exposure to Rituximab: a Systematic Review and Meta-Analysis.

Background: We designed this study to estimate pooled prevalence of preterm and term deliveries of women exposed to rituximab before pregnancy.

Methods: A systematic review using PRISMA guideline was conducted. We performed a comprehensive search in PubMed, Scopus, EMBASE and Web of Science databases based on a predefined search strategy. The search was done on the 1st of May 2023 and there were no time or language limitations. Data were analyzed using random effect model and all estimated effect sizes were reported at a confidence interval of 95%. Also, we used the I-square index (I²) to assess statistical heterogeneity.

Results: A literature search revealed 4059 records, of which 26 full-texts were evaluated, and finally, five studies remained for the systematic review. The pooled prevalence of term pregnancy in women with multiple sclerosis who were treated with rituximab was 64% (95% CI 31-96%) (I²=95.1%, P <0.001). The pooled prevalence of preterm pregnancy in women with MS who were treated with rituximab was 4% (95% CI 1-9%) (I²=16.6%, P=0.3).

Conclusion: The findings of this systematic review and meta-analysis indicate that rituximab exposure during conception is not associated with an increased rate of preterm deliveries.