PMID- 38261988
OWN - NLM
STAT- MEDLINE
DCOM- 20240125
LR  - 20240327
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Print)
IS  - 0028-3878 (Linking)
VI  - 102
IP  - 4
DP  - 2024 Feb 27
TI  - Disparities by Race in Pregnancy Care and Clinical Outcomes in Women With 
      Multiple Sclerosis: A Diverse Multicenter Cohort.
PG  - e208100
LID - 10.1212/WNL.0000000000208100 [doi]
LID - e208100
AB  - BACKGROUND AND OBJECTIVES: Racial disparities exist in both neurologic and 
      obstetric populations, underscoring the importance of evaluating pregnancy 
      outcomes in diverse women with multiple sclerosis (MS). The objective of this 
      multicenter retrospective study was to compare pregnancy care and outcomes 
      between Black and Hispanic (underrepresented) and White women with MS. METHODS: 
      Demographic and clinical data were extracted from medical records of 9 US MS 
      centers for women with MS/clinically isolated syndrome who delivered live births 
      between 2010 and 2021. Sites identified at last 15 consecutive Black/Hispanic 
      women and a matching number of White women. Socioeconomic factors, pregnancy, and 
      MS care/outcomes were compared between groups (underrepresented and White and 
      then Black and Hispanic) using Wilcoxon rank sum (U statistic and effect size r 
      reported), chi(2), t tests and logistic regressions as appropriate to data type. 
      Multiple imputation by chained equation was used to account for missing data. 
      RESULTS: Overall, 294 pregnancies resulting in live births were analyzed ( 81 
      Black, 67 Hispanic, and 146 White mothers). Relative to underrepresented women, 
      White women lived in areas of higher median (interquartile range [IQR]) Child 
      Opportunity Index (79 [45.8] vs 22 [45.8], U = 3,824, r = 0.56, p < 0.0001) and 
      were more often employed (84.9% vs 75%, odds ratio [OR] 2.57, CI 1.46-4.50, p = 
      0.0008) and privately insured (93.8% vs 56.8%, OR 11.6, CI 5.5-24.5, p < 0.0001) 
      and more received a 14-week ultrasound (98.6% vs 93.9%, OR 4.66, CI 0.99-21.96, p 
      = 0.027). Mode of delivery was significantly different between the three groups 
      (X(2)(10,294) = 20.38, p = 0.03); notably, Black women had the highest rates of 
      emergency cesarean deliveries, and Hispanic women highest rates of uncomplicated 
      vaginal deliveries. Babies born to underrepresented women had lower median (IQR) 
      birthweights than babies born to White women (3,198 g [435.3 g] vs 3,275 g [412.5 
      g], U = 9,255, r = 0.12, p = 0.04) and shorter median (IQR) breastfeeding 
      duration (4.5 [3.3] vs 6.0 [4.2] months, U = 8,184, r = 0.21, p = 0.003). While 
      underrepresented women were younger than White women (mean [SD] 30.9 [4.8] vs 
      33.8 [4.0], t = 1.97, CI 1.96-3.98, p < 0.0001), their median (Q1-Q3, IQR) 
      Expanded Disability Status Scale was higher (1.5 [1-2.5, 1.5] vs 1 [0-1.5, 1.5], 
      U = 7,260, r = 0.29, p < 0.0001) before pregnancy. Finally, medical records were 
      missing more key data for Black women (19.7% missing vs 8.9% missing, OR 2.54, CI 
      1.25-5.06, p = 0.008). DISCUSSION: In this geographically diverse multicenter 
      cohort, underrepresented women entered pregnancy with higher disability and fewer 
      health care resources. Pregnancy represents a pivotal window where structural 
      factors affect maternal and fetal health and neurologic trajectories; it is a 
      critical period to optimize care and health outcomes.
FAU - Radzik, Anne Marie
AU  - Radzik AM
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Amezcua, Lilyana
AU  - Amezcua L
AUID- ORCID: 0000-0003-1542-7819
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Anderson, Annika
AU  - Anderson A
AUID- ORCID: 0000-0002-7288-6344
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Gilmore, Serena
AU  - Gilmore S
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Ahmad, Sophie
AU  - Ahmad S
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Brandstadter, Rachel
AU  - Brandstadter R
AUID- ORCID: 0009-0002-3369-0928
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Fabian, Michelle T
AU  - Fabian MT
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Graham, Edith L
AU  - Graham EL
AUID- ORCID: 0000-0001-6862-5531
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Hodgkinson, Sophia
AU  - Hodgkinson S
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Horton, Lindsay
AU  - Horton L
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Jacobs, Dina A
AU  - Jacobs DA
AUID- ORCID: 0009-0005-6555-8712
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Katz Sand, Ilana B
AU  - Katz Sand IB
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Kohli, Amit
AU  - Kohli A
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Levine, Libby
AU  - Levine L
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - McLemore, Monica
AU  - McLemore M
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Okai, Annette F
AU  - Okai AF
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Patel, Jasmin
AU  - Patel J
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Poole, Shane
AU  - Poole S
AUID- ORCID: 0000-0002-3203-151X
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Riley, Claire
AU  - Riley C
AUID- ORCID: 0000-0002-2133-9607
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Satyanarayan, Sammita
AU  - Satyanarayan S
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Tardo, Lauren
AU  - Tardo L
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Verter, Elizabeth
AU  - Verter E
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Villacorta, Veronica
AU  - Villacorta V
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Zimmerman, Vanessa
AU  - Zimmerman V
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Zuroff, Leah
AU  - Zuroff L
AUID- ORCID: 0000-0002-8527-6174
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Williams, Mitzi J
AU  - Williams MJ
AUID- ORCID: 0000-0001-6979-1101
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Houtchens, Maria K
AU  - Houtchens MK
AUID- ORCID: 0000-0001-6077-0654
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
FAU - Bove, Riley
AU  - Bove R
AUID- ORCID: 0000-0002-2034-8800
AD  - From the University of California San Francisco (A.M.R.); Department of Neurology 
      (L.A.), University of Southern California, Los Angeles; Department of Neurology 
      (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department 
      of Neurology (S.G.), University of California San Francisco; Department of 
      Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of 
      Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of 
      Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., 
      I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of 
      Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., 
      M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., 
      L.T.), Dallas; Center for Translational and Computational Neuroimmunology and 
      Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia 
      University Irving Medical Center, New York, NY; Family Health Care Nursing 
      Department (M.M.), School of Nursing, University of California San Francisco; 
      North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of 
      Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), 
      Multiple Sclerosis Center, Smyrna, GA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20240123
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
SB  - IM
CIN - doi: 10.1212/WNL.0000000000209207
MH  - Infant
MH  - Pregnancy
MH  - Child
MH  - Humans
MH  - Female
MH  - *Multiple Sclerosis
MH  - Retrospective Studies
MH  - Prenatal Care
MH  - *Demyelinating Diseases
MH  - Mothers
PMC - PMC10962915
COIS- A.R. Radzik, M.T. Fabian, S. Ahmad, L. Horton, and M. McLemore report no 
      disclosures. L. Amezcua reports personal compensation for consulting or serving 
      on steering committees or advisory boards for Biogen Idec, Novartis, Genentech, 
      and EMD Serono; research support from the National MS Society, NIH National 
      Institute of Neurological Disorders and Stroke, Bristol Myer Squibb Foundation, 
      Race to Erase MS, and Biogen Idec; she is a local PI for commercial trials funded 
      by Genentech, and Sanofi Genzyme. E.L. Graham received consulting and advisory 
      board fees from Novartis, Atara Biotherapeutics, Tavistock Life Sciences, Horizon 
      Therapeutics, and Roche Genentech; she receives research support from F. 
      Hoffman-La Roche Ltd.; she received compensation for question writing from ACP 
      MKSAP. D.A. Jacobs reports research support from Biogen, Genentech, Novartis, 
      consulting and scientific advisory board fees from Biogen, Genentech, Novartis, 
      EMD Serono, Banner Life Sciences, Bristol Myers Squibb, Horizon, and Sanofi 
      Genzyme. I.B. Katz Sand reports research support from NIH, DoD, NMSS, and Guthy 
      Jackson Charitable Foundation. A.F. Okai has received speaking and consulting 
      fees from Alexion, Biogen, Bristol Myers Squibb, EMD Serono, Greenwich 
      Biosciences, Janssen, Novartis, Roche Genentech, Sanofi Genzyme, and TG 
      Therapeutics and research support from Alexion, EMD Serono, Novartis, Roche 
      Genentech Sanofi Genzyme, and TG Therapeutics. C.S. Riley reports consulting fees 
      or honoraria from EMD Serono, Genentech, Horizon Therapeutics, Janssen Global, 
      Novartis, and TG Therapeutics. L. Zuroff reports speaking fees from EMD Serono. 
      M.K. Houtchens received research support from CMSC, NMSS, Progressive MS 
      Alliance, Biogen, Novartis, and Roche Genentech and consulting fees from Serono, 
      Biogen, Jansen, and Novartis. R. Bove reports research support from NIH, DOD, 
      NSF, NMSS, Biogen, Novartis, and Roche Genentech; consulting and scientific 
      advisory board fees from Alexion, EMD Serono, Jansen, Horizon, and TG 
      Therapeutics. Go to Neurology.org/N for full disclosures.
EDAT- 2024/01/23 18:42
MHDA- 2024/01/25 06:43
PMCR- 2024/01/23
CRDT- 2024/01/23 16:13
PHST- 2024/01/25 06:43 [medline]
PHST- 2024/01/23 18:42 [pubmed]
PHST- 2024/01/23 16:13 [entrez]
PHST- 2024/01/23 00:00 [pmc-release]
AID - WNL-2023-002152 [pii]
AID - 10.1212/WNL.0000000000208100 [doi]
PST - ppublish
SO  - Neurology. 2024 Feb 27;102(4):e208100. doi: 10.1212/WNL.0000000000208100. Epub 
      2024 Jan 23.