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From the Departments of Epidemiology (Drs. Hernán, Spiegelman, and Ascherio), Biostatistics (Dr. Spiegelman) and Nutrition (Dr. Ascherio), Harvard School of Public Health, Boston; Multiple Sclerosis Clinic (Dr. Hohol), St. Michael’s Hospital, Toronto, Ontario; and the Center for Neurological Diseases-Multiple Sclerosis Unit (Dr. Olek), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.
Address correspondence and reprint requests to Dr. Miguel Hernán, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115; e-mail: miguel_hernan{at}post.harvard.edu
BACKGROUND: Experimental and clinical data suggest a protective effect of estrogens on the development and progression of MS.
METHODS: We assessed whether MS incidence was associated with oral contraceptive use or parity in two cohort studies of U.S. women, the Nurses’ Health Study (NHS; 121,700 women aged 30 to 55 years at baseline in 1976) and the Nurses’ Health Study II (NHS II; 116,671 women aged 25 to 42 years at baseline in 1989). Participants with a diagnosis of MS before baseline were excluded. Oral contraceptive history and parity were assessed at baseline and updated biennially. During follow-ups of 18 years (NHS) and 8 years (NHS II) we documented a total of 315 definite or probable cases of MS.
RESULTS: Neither use of oral contraceptives nor parity were significantly associated with the risk of MS. As compared with women who never used oral contraceptives, the age-adjusted relative risk (95% CI) was 1.2 (0.9, 1.5) for past users, and 1.0 (0.6, 1.7) for current users. Similar results were obtained after adjustment for latitude, ancestry, and other potential confounding factors. There was no clear trend of MS risk with either increasing duration of use or time elapsed since last use. Age at first birth was also not associated with the risk of MS.
CONCLUSIONS: These prospective results do not support a lasting protective effect of oral contraceptive use or pregnancy on the risk of MS. The decision to use hormonal contraception should not be affected by its effects on the risk of MS.
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