{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:05:34Z","timestamp":1789725934554,"version":"4.0.1"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"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"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pregnant women with multiple sclerosis have higher Cesarean section (C-section) rates than controls. Whether these are occurring prior to 39\u2009weeks\u2019 gestation is unclear and important, as C-sections &lt;39\u2009weeks are associated with increased neonatal morbidity and are not recommended unless medically indicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Determine whether pregnant women with multiple sclerosis experience higher rates of non-medically indicated C-sections &lt;39\u2009weeks and whether these were attributed to multiple sclerosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective, population-based case\u2013control study of pregnancies \u2a7e20\u2009weeks\u2019 gestation among pregnant women with multiple sclerosis and 2:1 matched controls (1 January 2009\u201330 June 2024). Electronic health records identified C-sections &lt;39\u2009weeks and were manually reviewed for outcomes and covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 600 MS pregnancies and 1199 controls, C-sections &lt;39\u2009weeks were more frequent in pregnant women with multiple sclerosis (15.2% vs 9.8%, p\u2009=\u20090.0007). However, non-medically indicated C-sections &lt;39\u2009weeks were uncommon and did not differ significantly between groups (pregnant women with multiple sclerosis 3.7% vs controls 2.8%, p\u2009=\u20090.3386). The higher proportion of medically indicated C-sections &lt;39\u2009weeks in pregnant women with multiple sclerosis (11.5% vs 6.9%, p\u2009=\u20090.001) was driven by high-risk myomectomy and stalled labor. Multiple sclerosis was documented as a pregnancy complication in 24.2% of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>C-sections &lt;39\u2009weeks were more common in pregnant women with multiple sclerosis but were attributable to standard obstetric indications rather than multiple sclerosis. Documentation of multiple sclerosis as a pregnancy complication suggests persistent provider misconceptions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261481729","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:49:11Z","timestamp":1788504551000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cesarean sections prior to 39 weeks among pregnant patients with multiple sclerosis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2270-915X","authenticated-orcid":false,"given":"Mandisa L.","family":"Keswa","sequence":"first","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6495-6085","authenticated-orcid":false,"given":"Sana R.","family":"Desai","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0422-6859","authenticated-orcid":false,"given":"Francesca K.","family":"Dzukou","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6585-323X","authenticated-orcid":false,"given":"Jessica B.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1606-5381","authenticated-orcid":false,"given":"Irogue I.","family":"Igbinosa","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6891-7147","authenticated-orcid":false,"given":"Annette M.","family":"Langer-Gould","sequence":"additional","affiliation":[{"name":"Neurology Department, Los Angeles Medical Center, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Bader AM Hunt CO Datta S et al. 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