Study: Higher rates of C-sections before 39 weeks in people with MS are driven by standard obstetric reasons, not MS itself

# What the study looked at

# Main findings Early cesarean deliveries—those before 39 weeks of gestation—were more common among pregnancies in people with MS than in the matched control group (15.2% vs. 9.8%). The gap was mainly in medically indicated early C-sections: 11.5% of pregnancies in the MS group had medically indicated early C-sections versus 6.9% in controls. Nonmedically indicated early C-sections were low and similar between groups (3.7% vs. 2.8%).

MS itself was rarely listed as the reason for early C-section—documented in only two cases. The study also found that medical records often listed MS as a pregnancy complication or cited it as a reason for referral to high-risk pregnancy care.

# Outcomes and patient characteristics Newborn outcomes did not differ meaningfully between people with MS and controls who underwent early C-sections. Age, race/ethnicity, and parity were comparable between groups among those who had early C-sections. More than 73% of pregnancies in both groups involved at least one other health condition at conception.

Two notable differences in pre-pregnancy health were observed: a higher proportion of people with MS had a mental health condition at conception (27.5% vs. 2.8%), while diabetes was less common in the MS group (6.5% vs. 16%).

# What this means for patients and providers The data suggest that the higher rate of early C-sections in pregnancies among people with MS is tied to routine obstetric indications rather than to MS itself. The near-absence of MS listed as the direct cause of early C-section and the lack of an association between stalled labor and documented MS-related physical limitations point toward clinical reasons or referral patterns driving the difference.

The authors recommend comprehensive patient counseling and actions to address persistent provider misconceptions that may lead to labeling MS as a pregnancy complication or to precautionary referrals. They call for future research on how provider perceptions and counseling practices affect maternal mental health and for interventional studies to correct misperceptions about pregnancy risk in MS.

# Bottom line Early, medically indicated C-sections are more frequent in pregnancies of people with MS in this health-system cohort, but those surgeries largely reflect standard obstetric problems rather than direct effects of MS. Documentation practices and provider perceptions appear relevant to how pregnancy risk is communicated and managed in this population.