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Investigating the Long-term Effect of Pregnancy on the Course of Multiple Sclerosis Using Causal Inference.

dc.rights.licenseopenen_US
dc.contributor.authorGAVOILLE, Antoine
dc.contributor.authorROLLOT, Fabien
dc.contributor.authorCASEY, Romain
dc.contributor.authorDEBOUVERIE, Marc
dc.contributor.authorLE PAGE, Emmanuelle
dc.contributor.authorCIRON, Jonathan
dc.contributor.authorDE SEZE, Jerome
hal.structure.identifierNeurocentre Magendie : Physiopathologie de la Plasticité Neuronale [U1215 Inserm - UB]
dc.contributor.authorRUET, Aurelie
dc.contributor.authorMAILLART, Elisabeth
dc.contributor.authorLABAUGE, Pierre
dc.contributor.authorZEPHIR, Helene
dc.contributor.authorPAPEIX, Caroline
dc.contributor.authorDEFER, Gilles
dc.contributor.authorLEBRUN-FRENAY, Christine
dc.contributor.authorMOREAU, Thibault
dc.contributor.authorLAPLAUD, David Axel
dc.contributor.authorBERGER, Eric
dc.contributor.authorSTANKOFF, Bruno
dc.contributor.authorCLAVELOU, Pierre
dc.contributor.authorTHOUVENOT, Eric
dc.contributor.authorHEINZLEF, Olivier
dc.contributor.authorPELLETIER, Jean
dc.contributor.authorAL-KHEDR, Abdullatif
dc.contributor.authorCASEZ, Olivier
dc.contributor.authorBOURRE, Bertrand
dc.contributor.authorCABRE, Philippe
dc.contributor.authorWAHAB, Abir
dc.contributor.authorMAGY, Laurent
dc.contributor.authorCAMDESSANCHE, Jean-Philippe
dc.contributor.authorMAUROUSSET, Aude
dc.contributor.authorMOULIN, Solène
dc.contributor.authorBEN, Nasr Haifa
dc.contributor.authorBOULOS, Dalia Dimitri
dc.contributor.authorHANKIEWICZ, Karolina
dc.contributor.authorNEAU, Jean-Philippe
dc.contributor.authorPOTTIER, Corinne
dc.contributor.authorNIFLE, Chantal
dc.contributor.authorRABILLOUD, Muriel
dc.contributor.authorSUBTIL, Fabien
dc.contributor.authorVUKUSIC, Sandra
dc.date.accessioned2023-09-25T13:08:02Z
dc.date.available2023-09-25T13:08:02Z
dc.date.issued2023-03-21
dc.identifier.issn1526-632Xen_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/183793
dc.description.abstractEnThe question of the long-term safety of pregnancy is a major concern in patients with multiple sclerosis (MS), but its study is biased by reverse causation (women with higher disability are less likely to experience pregnancy). Using a causal inference approach, we aimed to estimate the unbiased long-term effects of pregnancy on disability and relapse risk in patients with MS and secondarily the short-term effects (during the perpartum and postpartum years) and delayed effects (occurring beyond 1 year after delivery). We conducted an observational cohort study with data from patients with MS followed in the Observatoire Français de la Sclérose en Plaques registry between 1990 and 2020. We included female patients with MS aged 18-45 years at MS onset, clinically followed up for more than 2 years, and with ≥3 Expanded Disease Status Scale (EDSS) measurements. Outcomes were the mean EDSS score at the end of follow-up and the annual probability of relapse during follow-up. Counterfactual outcomes were predicted using the longitudinal targeted maximum likelihood estimator in the entire study population. The patients exposed to at least 1 pregnancy during their follow-up were compared with the counterfactual situation in which, contrary to what was observed, they would not have been exposed to any pregnancy. Short-term and delayed effects were analyzed from the first pregnancy of early-exposed patients (who experienced it during their first 3 years of follow-up). We included 9,100 patients, with a median follow-up duration of 7.8 years, of whom 2,125 (23.4%) patients were exposed to at least 1 pregnancy. Pregnancy had no significant long-term causal effect on the mean EDSS score at 9 years (causal mean difference [95% CI] = 0.00 [-0.16 to 0.15]) or on the annual probability of relapse (causal risk ratio [95% CI] = 0.95 [0.93-1.38]). For the 1,253 early-exposed patients, pregnancy significantly decreased the probability of relapse during the perpartum year and significantly increased it during the postpartum year, but no significant delayed effect was found on the EDSS and relapse rate. Using a causal inference approach, we found no evidence of significantly deleterious or beneficial long-term effects of pregnancy on disability. The beneficial effects found in other studies were probably related to a reverse causation bias.
dc.description.sponsorshipObservatoire Français de la Sclérose en Plaques - ANR-10-COHO-0002en_US
dc.language.isoENen_US
dc.subject.enPregnancy
dc.subject.enHumans
dc.subject.enFemale
dc.subject.enMultiple Sclerosis
dc.subject.enCohort Studies
dc.subject.enProbability
dc.subject.enDisabled Persons
dc.subject.enRecurrence
dc.subject.enMultiple Sclerosis
dc.subject.enRelapsing-Remitting
dc.subject.enDisease Progression
dc.title.enInvestigating the Long-term Effect of Pregnancy on the Course of Multiple Sclerosis Using Causal Inference.
dc.title.alternativeNeurologyen_US
dc.typeArticle de revueen_US
dc.subject.halSciences du Vivant [q-bio]/Neurosciences [q-bio.NC]en_US
dc.identifier.pubmed36564207en_US
bordeaux.journalNeurologyen_US
bordeaux.pagee1296-e1308en_US
bordeaux.volume100en_US
bordeaux.hal.laboratoriesNeurocentre Magendie - U1215en_US
bordeaux.issue12en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamRelations glie-neuroneen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.identifier.funderIDFondation pour l'Aide à la Recherche sur la Sclérose en Plaquesen_US
bordeaux.import.sourcepubmed
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exportfalse
workflow.import.sourcepubmed
dc.rights.ccPas de Licence CCen_US
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