Erin Kelly1, Casey Engel2, Rylan Pearsall2, Myla Goldman3
1Virginia Commonwealth University School of Medicine, 2University of Virginia, 3VCU Health Department of Neurology
Objective:
A study from 2 MS centers to assess the impact of multiple sclerosis (MS) diagnosis on women’s reproductive choices, experiences, and attitudes. Experiential survey data of women with MS was analyzed in context of pregnancy year(s), race, ethnicity, and zip code.
Background:
MS commonly affects women in their childbearing years, necessitating discussion between patients and their MS treatment team around the issues of family planning, pregnancy, and postpartum. Expanding MS therapies and limited available research complicates patient choices.
Design/Methods:
1000 women (Center A) and 1517 women (Center B) with MS diagnosis were invited to participate in a survey study. Pregnancy history, and, if appropriate, reasons for pregnancy avoidance were collected from all respondents. Race, ethnicity, and zip code were collected from Center B respondents only. Women with ≥ 1 pregnancy after MS diagnosis were queried regarding counseling received, pregnancy complications, and delivery & postpartum outcomes.
Results:
Among the 277 respondents, 79.4% reported no pregnancy following MS diagnosis. Of these, 19.8% indicated decision driven by MS-related concerns including: MS worsening with pregnancy (47%); ability to care for child secondary to MS (35%); passing MS onto child (19%); stopping DMT to attempt pregnancy (12%); lack of knowledge about options for pregnancy and MS (9%). Women with a pregnancy in more recent decades were significantly more likely to report that a neurologist counseled them surrounding MS and pregnancy (Chi Square, p=0.011). Breastfeeding initiation was reported in 73.8% of mothers in post-diagnosis pregnancy (median duration 6 months, IQR 1.75- 11). From Center B, 23.8% of respondents self-identified as Black.
Conclusions:
Pregnancy avoidance following MS diagnosis is multi-faceted. Guidance surrounding the safety and feasibility of pregnancy with MS is varied and has changed over time. Improvements in counseling surrounding MS and pregnancy may be driven by recent increased research in the field.