{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:19:23Z","timestamp":1790119163174,"version":"4.0.1"},"reference-count":32,"publisher":"SAGE Publications","issue":"11-12","license":[{"start":{"date-parts":[[2024,9,12]],"date-time":"2024-09-12T00:00:00Z","timestamp":1726099200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Evidence on the impact of dimethyl fumarate (DMF) during pregnancy in women with multiple sclerosis (MS) is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To investigate disease activity and pregnancy outcomes in a retrospective cohort of women exposed to DMF in early pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Women discontinuing DMF after pregnancy confirmation were identified from 29 Italian MS Centers. Disease activity 12 months before conception, during pregnancy, and 12 months postpartum were recorded, exploring reactivation predictors. Pregnancy and fetal outcomes were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study analyzed 137 pregnancies (12 pregnancy losses, 125 live births) from 137 women (mean age 32.9 \u00b1 4.7 years), discontinuing DMF within a median (interquartile range (IQR)) interval of 4.9 (3.7\u20135.7) weeks from conception. In live birth pregnancies, annualized relapse rate (ARR) significantly decreased during pregnancy (ARR = 0.07, 95% confidence interval (CI): 0.03\u20130.14, p = 0.021) compared to pre-conception (ARR = 0.21 (95% CI: 0.14\u20130.30)) and increased postpartum ((ARR = 0.22 (95% CI: 0.15\u20130.32), p = 0.006). Median time to first relapse (TTFR) was 3.16 (IQR: 1:87\u20135.42) months. Higher pre-conception relapse number (hazard ratio (HR) = 2.33, 95% CI: 1.08\u20135.02) and Expanded Disability Status Scale (EDSS; HR = 1.81, 95% CI: 1.17-2.74) were associated with shorter TTFR, while treatment resumption with longer TTFR (HR = 0.29, 95% CI: 0.11\u20130.74). Fetal outcomes were unaffected by DMF exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>DMF discontinuation does not increase relapse risk during pregnancy. Early therapy restart prevents postpartum relapses. Early DMF exposure shows no adverse fetal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585241274600","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T22:24:24Z","timestamp":1726266264000},"page":"1503-1513","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Maternal and fetal outcomes in an Italian multicentric cohort of women with multiple sclerosis exposed to dimethyl fumarate during pregnancy"],"prefix":"10.1177","volume":"30","author":[{"given":"Doriana","family":"Landi","sequence":"first","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Fondazione PTV Policlinico Tor Vergata, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9743-6251","authenticated-orcid":false,"given":"Silvia","family":"Bartolomeo","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Fondazione PTV Policlinico Tor Vergata, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3823-4000","authenticated-orcid":false,"given":"Francesca","family":"Bovis","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3325-3760","authenticated-orcid":false,"given":"Maria Pia","family":"Amato","sequence":"additional","affiliation":[{"name":"Department NEUROFARBA, University of Florence, Florence, Italy"},{"name":"IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Bonavita","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli,\u201d Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Borriello","sequence":"additional","affiliation":[{"name":"MS Center, Neurology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy"},{"name":"Department of Public Health, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Buccafusca","sequence":"additional","affiliation":[{"name":"Neurology and Neuromuscular Unit, Multiple Sclerosis Centre, \u201cG. Martino\u201d University Hospital, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0965-2665","authenticated-orcid":false,"given":"Sebastiano","family":"Bucello","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Centre, \u201cE. Muscatello\u201d Hospital\u2014ASP8, Augusta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4589-4864","authenticated-orcid":false,"given":"Paola","family":"Cavalla","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Cellerino","sequence":"additional","affiliation":[{"name":"Clinica Neurologica, Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Centonze","sequence":"additional","affiliation":[{"name":"Italy Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University, Rome, Italy"},{"name":"Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3878-8820","authenticated-orcid":false,"given":"Eleonora","family":"Cocco","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Conte","sequence":"additional","affiliation":[{"name":"IRCCS Neuromed, Pozzilli, Italy; Department of Human Neuroscience, Sapienza University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Cortese","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Centre, S. Filippo Neri Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Di Filippo","sequence":"additional","affiliation":[{"name":"Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Docimo","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli,\u201d Naples, Italy"},{"name":"Multiple Sclerosis Center, \u201cSan Giuseppe Moscati\u201d Hospital, ASL Caserta, Aversa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Fantozzi","sequence":"additional","affiliation":[{"name":"Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Ferraro","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Centre, S. Filippo Neri Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5485-0479","authenticated-orcid":false,"given":"Massimo","family":"Filippi","sequence":"additional","affiliation":[{"name":"Neurology Unit, Multiple Sclerosis Center, IRCCS San Raffaele Institute, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Foschi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Multiple Sclerosis Center, Neurology Unit, S. Maria delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, Italy"},{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Gallo","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center, Department of Advanced Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli,\u201d Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Granella","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma, Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-0944","authenticated-orcid":false,"given":"Antonio","family":"Ianniello","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience, Sapienza University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Lanzillo","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical Care, Department of Neurosciences and Reproductive and Odontostomatological Sciences, University \u201cFederico II,\u201d Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2050-2908","authenticated-orcid":false,"given":"Lorena","family":"Lorefice","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center, Department of Medical Sciences and Public Health, Binaghi Hospital, ASL Cagliari, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0447-2297","authenticated-orcid":false,"given":"Matteo","family":"Lucchini","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d IRCCS, Rome, Italy"},{"name":"Department of Neurosciences, Centro di Ricerca per la Sclerosi Multipla (CERSM), Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Lus","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center, II Neurological Clinic, University of Campania \u201cLuigi Vanvitelli,\u201d Naples, Italy"},{"name":"Department of Medical and Surgical Sciences, University of Campania \u201cLuigi Vanvitelli,\u201d Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Mataluni","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Fondazione PTV Policlinico Tor Vergata, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7783-114X","authenticated-orcid":false,"given":"Massimiliano","family":"Mirabella","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d IRCCS, Rome, Italy"},{"name":"Department of Neurosciences, Centro di Ricerca per la Sclerosi Multipla (CERSM), Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6313-4952","authenticated-orcid":false,"given":"Lucia","family":"Moiola","sequence":"additional","affiliation":[{"name":"Neurology Unit, Multiple Sclerosis Center, IRCCS San Raffaele Institute, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Napoli","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Fondazione PTV Policlinico Tor Vergata, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Gabri","family":"Nicoletti","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Fondazione PTV Policlinico Tor Vergata, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6923-0846","authenticated-orcid":false,"given":"Francesco","family":"Patti","sequence":"additional","affiliation":[{"name":"Department \u201cG.F. 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girolama Alessandra","family":"Marfia","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Fondazione PTV Policlinico Tor Vergata, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,9,12]]},"reference":[{"key":"bibr1-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199807303390501"},{"key":"bibr2-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awh152"},{"key":"bibr3-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-022-11215-7"},{"key":"bibr4-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1177\/1352458513507816"},{"key":"bibr5-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2022-329657"},{"key":"bibr6-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.44750"},{"key":"bibr7-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-021-01106-6"},{"key":"bibr8-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200110"},{"key":"bibr9-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1177\/13524585231220232"},{"key":"bibr10-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012084"},{"key":"bibr11-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2018-002060"},{"key":"bibr12-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00426-4"},{"key":"bibr13-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1177\/13524585221129472"},{"key":"bibr14-13524585241274600","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2018.00005"},{"key":"bibr15-13524585241274600","unstructured":"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/tecfidera-epar-product-information_en.pdf"},{"key":"bibr16-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1002\/pds.5411"},{"key":"bibr17-13524585241274600","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30470-2"},{"key":"bibr18-13524585241274600","unstructured":"EUROCAT 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