Risk of postpartum infection after cesarean section in women with multiple sclerosis: A population-based cohort study

OBJECTIVE: Cesarean section (CS) rates are increased in women with multiple sclerosis (MS). It is unknown whether CS in women with MS constitutes a risk of maternal postpartum infection compared to vaginal delivery. METHODS: We used the Danish national health registers to establish a cohort of all live births by women with MS in Denmark from 1995 to 2023. We estimated the risk of maternal postpartum infections according to the mode of delivery in women with MS using logistic regression models adjusted for confounders such as age, body mass index, and comorbidity. RESULTS: Overall, 872 women with MS gave birth to their child by CS, and 2542 women with MS had a vaginal birth. Within the postpartum period of 42 days, 21.0% with CS and 14.1% with vaginal birth had an infectious complication. The overall risk of infections among women with MS giving birth by CS, relative to those with vaginal delivery, was an adjusted odds ratio (aOR) of 1.54, 95% confidence interval (95% CI 1.18-2.01). The risk of mild to moderate infections (prescriptions of antibiotics) was aOR 1.60 (95% CI 1.24-2.08), and the risk of severe infections (hospital-diagnosed) was aOR 1.55 (95% CI 0.82-2.94). CONCLUSION: Women with MS who give birth by CS have an increased risk of postpartum infection compared to women with MS who give birth vaginally. This is important to be aware of since infection can cause worsening of neurological symptoms or trigger a new relapse in patients with MS.