Abstract
Background: It is well established that multiple sclerosis (MS) disease activity remits during pregnancy. However, the immunological and molecular mechanisms that drive remission during pregnancy are poorly understood.
Objective: To establish a globally unique cohort of prospectively assessed Australian women with MS (wwMS) who have never been pregnant (nulligravida) together with a nulligravida control cohort and characterise their demographic and clinical characteristics. To closely monitor these women through their first pregnancies, undertaking deep immunological, molecular and environmental phenotyping.
Methods: Women recruited from seven MS centres, and two obstetric clinics are assessed at baseline, first and third pregnancy trimesters, three and twelve months postpartum. Demographic, lifestyle and health questionnaires are completed and 65-120ml blood donated at each visit. Clinical data are obtained from MSBase. Peripheral Blood Mononuclear Cells are immunophenotyped and sorted for T-cell subsets, B-cells, Monocytes and NK-cells for molecular analyses. Serum and Plasma are stored for proteomic analyses.
Results: We have recruited 69 women comprising 37 wwMS and 32 controls. 10 wwMS and 15 controls have fallen pregnant. MS and control cohorts are well balanced for ethnicity, income and employment. Primigravida women are aged between 28-39.3 years; wwMS are slightly older (34.4 years, SD 2.8) at conception than healthy primigravida controls (31.6 years, SD 2.8). At baseline 31% of wwMS were using natalizumab, 42% were using B-cell depleting agents.
Conclusion: Study recruitment is ongoing. Sociodemographic, environmental and health outcomes in pregnant wwMS will be examined, and compared against non-MS controls. The immunobiological mechanisms that underpin MS remission in pregnancy will be explored once recruitment targets have been reached.