PT -期刊文章盟Gavoille安东尼盟——我,法盟-凯西,罗曼盟——Debouverie Marc盟——Le页面之盟,Ciron乔纳森•AU - De Seze杰罗姆盟——Ruet Aurelie AU - Maillart伊丽莎白盟——Labauge皮埃尔盟——Zephir Helene盟——Papeix卡罗琳盟——推迟,Gilles盟——Lebrun-Frenay鳌-莫罗,蒂博盟——Laplaud大卫阿克塞尔非盟-伯杰,埃里克·AU - Stankoff布鲁诺盟——Clavelou皮埃尔盟——Thouvenot埃里克•AU - Heinzlef Olivier AU -佩尔蒂埃,Jean AU - Al Khedr, Abdullatif AU - Casez, Olivier AU - Bourre, Bertrand AU - Cabre, Philippe AU - Wahab, Abir AU - Magy, Laurent AU - Camdessanche, Jean-Philippe AU - Maurousset, Aude AU - Moulin, Solène AU - Ben, Nasr haousset AU - Boulos, Dalia Dimitri AU - Hankiewicz, Karolina AU - Neau, Jean-Philippe AU - Pottier, Corinne AU - Nifle, Chantal AU - Rabilloud, Muriel AU - Subtil, Fabien AU - Vukusic, Sandra AU -，TI -使用因果推断辅助调查怀孕对多发性硬化症病程的长期影响- 10.1212/WNL.0000000000206774DP - 2023 3月21日TA -神经学半岛投注体育官网PG - e1296- e1308 VI - 100 IP - 12 4099 - //www.ebmtp.com/content/100/12/e1296.short 4100 - //www.ebmtp.com/content/100/12/e1296.full SO -神经学2023 3月21日;背景和目标妊娠的长期安全性问题是多发性硬化症(MS)患者的主要担忧，但其研究因反向因果关系(残疾程度较高的女性不太可能怀孕)而存在偏见。使用因果推断方法，我们旨在评估妊娠对MS患者残疾和复发风险的无偏倚长期影响，其次是短期影响(产前和产后几年)和延迟影响(分娩后1年以上发生)。方法我们对1990年至2020年在Observatoire Français de la Sclérose en斑块登记处随访的MS患者的数据进行了一项观察性队列研究。我们纳入了MS发病时年龄在18-45岁，临床随访时间超过2年，并且有≥3项扩展疾病状态量表(EDSS)测量的女性MS患者。结果为随访结束时的平均EDSS评分和随访期间的年复发概率。在整个研究人群中使用纵向目标最大似然估计器预测反事实结果。在随访期间暴露于至少一次怀孕的患者与反事实情况进行了比较，在这种情况下，与所观察到的相反，他们不会暴露于任何怀孕。 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).Results 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.Discussion 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.DAG=directed acyclic graph; EDSS=Expanded Disease Status Scale; IPW=inverse probability weighting; LTMLE=longitudinal targeted maximum likelihood estimator; MS=multiple sclerosis; OFSEP=Observatoire Français de la Sclérose en Plaques; PP=primary progressive; RR=relapsing-remitting; SP=secondary progressive

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