Analysis of Pregnancy Complications and Offspring Outcomes in Multiple Sclerosis Using National Health Care Data in Korea

초록

Introduction: Multiple Sclerosis (MS) is a rare CNS demyelinating disease in Korea. Pregnancies in patients with MS are often considered high risk due to a higher incidence of obstetric complications and an increased likelihood of relapse. However, the pregnancy-related complications and fetal outcomes in patients with MS remain uncertain. Objectives/Aims: We investigated pregnancy-related and fetal complications in patients with MS using data from the National Health Insurance Service (NHIS) in Korea. Methods: We analyzed NHIS claim data, including information from the National Health Screening Examination (NHSE) and National Health Screening Program for Infants and Children in Korea. Our cohort consisted of pregnant women with MS (pgMS) and matched controls, selected based on age and Charlson Comorbidity Index. This study included women with singleton pregnancies with live births from 2011 to 2020 who had participated in the NHSE within 4 years prior to pregnancy. We assessed pregnancy complications (e.g., gestational hypertension) and offspring outcomes (e.g., congenital malformations). Propensity score matching and multivariable logistic regression were used to estimate the risk of maternal complications and fetal outcomes. All statistical analyses were performed using SPSS (ver. 23.0), and p-value < 0.05 was considered statistically significant. Results: A total of 3,904,808 women who delivered between 2011 and 2020, 481 (0.012%) were diagnosed with MS. PgMS had higher rates of hypertension (2.49% vs. 0.98%, p = 0.0002) and diabetes mellitus (DM) (7.48% vs. 2.37%, p < 0.0001). However, no significant differences were observed in obstetric complications, including gestational DM (p = 0.06), placental abruption (p = 0.64), and postpartum hemorrhage (p = 0.64). However, preterm birth (p = 0.002) and placenta previa (p = 0.03) were observed at higher rates in pgMS. The offspring of MS patients had a higher incidence of congenital malformations of the respiratory system (1.25% vs. 0.44%, p < 0.01) and musculoskeletal system (6.86% vs. 4.39%, p = 0.01). In the analysis of neonatal complications, there were no significant differences in respiratory distress syndrome (p = 0.06), bronchopulmonary dysplasia (p = 0.14), or hypoglycemia (p = 0.60). In multivariable regression analysis, fetal outcomes showed significant differences in preterm birth (OR 2.46, 95% CI 1.35–4.48) and placenta previa (OR 1.788, 95% CI 1.01–3.15) after adjustment. Neonatal complications did not differ in pgMS after adjustment. Conclusion: We evaluated maternal and fetal complications and neonatal systemic malformations in pgMS, compared to healthy pregnant women. PgMS did not show increased risks for most obstetric complications or neonatal congenital malformations compared to the general population. However, there was a higher risk of preterm delivery or placenta previa among pgMS. Further research through MS pregnancy registries or prospective studies is needed to better understand the risks associated with MS.