Elevated concentration of C-reactive protein is associated with pregnancy-related co-morbidities but not with relapse activity in multiple sclerosis

Abstract

During pregnancy, alterations take place in mother's immune system with the goal of maintaining a successful pregnancy, and delivering healthy offspring. Immune alterations include activation of the innate immune system and dampening of cell-mediated adaptive immunity. Due to these alterations, cell-mediated autoimmune diseases typically ameliorate during pregnancy. The objectives of this study were to evaluate whether C-reactive protein (CRP) concentration, a sensitive marker of systemic inflammation (1) is increased during MS pregnancy (2) predicts pregnancy-related co-morbidities associated with MS (3) predicts MS disease activity after delivery. CRP concentration was measured using a high sensitivity assay from seven prospectively collected serum samples of 41 MS patients and 19 controls during pregnancy and 6 months after delivery. Annualized relapse rates, EDSS, fatigue scores and obstetric details of the patients were recorded. Delivery-related CRP levels were significantly elevated both among MS patients and in controls. CRP levels were higher during pregnancy than during the postpartum period in both study groups. Delivery-related elevated CRP levels did not correlate with postpartum disease activity. MS patients with eventual gestational diabetes had a significantly higher median CRP in the beginning of pregnancy compared to non-diabetic MS patients (9.28 vs. 2.98 mg/l, p = 0.0025). MS patients reporting fatigue had a significantly higher CRP throughout pregnancy compared to patients without fatigue. Higher CRP values were associated with pregnancy-related co-morbidities but not with MS disease activity.

Connecting the dots: the role of fatigue in female infertility

“…The modified Kupperman Menopausal Index Ates et al 2022 [58] Matched pair study (POI, N = 62; Control, N = 62) Fatigue did not differ significantly between the groups Fatigue Severity Scale Premature Ovarian Failure Stege et al 2008 [59] Case-control study (POF, N = 81; Control, N = 68) Fatigue did not differ significantly between the groups The Shortened Fatigue Questionnaire higher CRP, an indicator of systemic inflammation, may be somewhat predictive of pregnancy-related comorbidities [68]. A small single-center retrospective study revealed that more patients with MS underwent elective cesarean deliveries due to fatigue [69].…”

“…These dysregulations involve cell-mediated immunity, including impairment of the function of NK cells, hypo-reactivity of T cells to the antigen, the activation of monocyte macrophages, and the persistence of autoreactive cells [116]. Concurrently, they manifest as changes in many inflammation-related markers, such as increased CRP levels [68], elevation in pro-inflammatory factors like interleukin-1β, interleukin-6, interleukin-12, interleukin-2, tumor necrosis factor-alpha and interferon-gamma, increased expression of nuclear factor kappa-B, as well as decreased levels of anti-inflammatory factors like interleukin-8, interleukin-13, interleukin-15, and interleukin-23 [117]. The changes in inflammationrelated profile support that patients experiencing fatigue are in a low-grade inflammatory state.…”