Helen Tremlett

Few population-based, methodologically rigorous studies have evaluated the association between mental health and health behaviours in MS. The goal of this dissertation is to contribute to the broader understanding of these relationships and their potential impact on MS. This dissertation was based on two main cohorts: 1) a multi-site clinic-based longitudinal cohort from across Canada; 2) a population-based health administrative and clinical cohort in British Columbia. A large (n=949) sample of MS patients were recruited from four Canadian MS clinics. Participants completed a series of questionnaires at three visits over two years. The prevalence of psychiatric comorbidities (depression [35%] and anxiety [54%]), and adverse health behaviours (smoking [24%] and non-adherence to disease-modifying therapies (DMTs) [22%]) was high. Alcohol dependence was associated with increased odds of anxiety (Odds Ratio (OR):1.84;95% confidence interval (CI):1.32–2.58) and depression (OR:1.53;95%CI:1.05–2.23), as was smoking (anxiety OR:1.29;95% CI:1.02–1.63; depression OR:1.37;95%CI:1.04–1.78). Non-adherence (
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No abstract available.

Multiple sclerosis (MS) is a putative autoimmune disease of the central nervoussystem, affecting many adults of childbearing age. Although extensive research hasexamined the association between MS and traditional perinatal outcomes (i.e. cesareansection, birth weight and preterm birth), other important outcomes are understudied,partly due to existing methodological challenges. Using comprehensive populationbaseddatabases including the British Columbia (BC) MS Database, BC PerinatalDatabase Registry, Vital Statistics Birth Registry, Population Data BC Consolidation Fileand Census GeoData, this dissertation investigated the association between MS (andrelated clinical factors) with: labour induction and augmentation; obstetrical epidural andspinal anesthesia; length of birth hospitalization in mothers and their newborns; as wellas birth outcomes in fathers with MS. Overall, individuals with MS were not at increasedrisk for the investigated outcomes compared to the general population with theexception that multiparous women with MS had higher rates of epidural anesthesiacompared to multiparous women in the general population. Within MS women, thosewith longer disease duration had less epidural anesthesia and those with greaterdisability had more labor induction. Men with greater MS disability tended to fatheroffspring with lower mean birth weight, but their newborns were still within the normalrange for the general population.Individuals with MS who wish to have children must also decide betweeninitiating disease-modifying drug (DMD) early to minimize relapses (i.e. MS attacks) ordelaying/stopping therapy prior to conception to avoid potential fetal harm from in uteroDMD exposure. This dissertation explored perinatal outcomes in women and men with iiiMS exposed to DMDs and includes a systematic review of DMD exposure on perinatal outcomes. Data from BC suggest that DMD exposure in men and women with MS does not increase the risk of unfavorable perinatal outcomes. However, best evidence from the systematic review indicates that interferon-beta exposure in women with MS is associated with preterm birth, lower mean birth weight and shorter mean birth length in newborns; nonetheless, growth parameters of exposed newborns remained within normal values for the general population and preterm births tended to be close to term.

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