Inclusion Criteria:
The following overall criteria for study inclusion are applied:
* Pregnancy with a recorded start and end of pregnancy outcome (live birth, spontaneous abortion, elective termination, stillbirth, or ectopic pregnancy) during the inclusion period
* Age 18-49 years at index date
* A diagnosis of MS before the index date. This inclusion criterion is based on diagnosis codes, as recorded in the different data sources
* Availability of information on exposure to MSDMDs and maternal baseline characteristics for a minimum of 12 months before the index date
In addition, the following outcome and objective specific inclusion criteria are applied:
* For analyses of MCMs in live births (primary objective): pregnancy ending in at least one live birth
* For analyses of spontaneous abortion, elective termination of pregnancy, stillbirth, preeclampsia, eclampsia (secondary objectives): pregnancy ending in at least one live birth, spontaneous abortion, elective termination, stillbirth, or ectopic pregnancy
* For analyses of preterm birth, SGA (secondary objectives): pregnancy ending in at least one live birth
* For analyses of MCMs among live births, spontaneous abortions, stillbirths, and elective terminations (exploratory objective): pregnancy ending in at least one live birth, spontaneous abortion, still birth, or elective termination
* For analyses of neonatal infection: live newborn
* For analyses of SII: newborn alive at 29 days after birth
Exclusion Criteria:
The following overall criteria for exclusion are applied:
* Pregnancy exposed to a MSDMD that have a known teratogenic effect, determined based on the date of prescription, estimated supply duration, and the drug-specific window of clearance
* Pregnancy exposed to a non-MSDMD that have a known moderate to high teratogenic effect, determined based on the date of prescription, estimated supply duration, and the drug-specific window of clearance
The following outcome specific exclusion criteria are applied:
* For analyses of MCMs and exploratory analyses of MCMs: pregnancies with a record of a chromosomal abnormality or a genetic syndrome
* For analyses of preterm birth, pre-eclampsia, eclampsia and SGA, pregnancies involving multiples
* For Kesimpta and MSDMD-exposed cohorts: pregnancies not exposed during the outcome specific risk period