Thursday, 12 June 2014

Clinic Speak: How much does your neuro know about pregnancy

What does your neurologist know about MS and pregnancy? #ClinicSpeak #MSBlog #MSResearch

"The following survey of neurologists in Germany is sobering. It suggests that knowledge about MS and  issues related to pregnancy is poor. The authors suggest that MSers seek out neurologists with a lot of experience in MS to counteract this problem. I am not sure that is feasible in the NHS. When you live in a large metropolis such as London, the Southeast of England or the Northwest of England this may be feasible, but for the large majority of MSers they have to engage with their local team. A far better solution than voting with your feet is education and self-empowerment. Most, if not all MSers, should be able in the modern era to get up to speed with issues in relation to pregnancy themselves. Self-management is becoming the order of the day. I have previously posted on pregnancy on this blog and have tabulated a list of questions that your neurologist and MS clinical nurse specialist should be able to answer in relation to this issue. If you are woman MSers I would be interested to hear about your personal experiences in relation to the issues raised by this study and post."


"The following is the list of question that you may need answered about pregnancy:"

  1. Does MS affect my fertility? 
  2. Will pregnancy affect the course of my MS? 
  3. Will I be able to breast feed after delivery? 
  4. How long before I fall pregnant must I stop my DMT? 
  5. If I fall pregnant on a DMT will this affect the baby? 
  6. Can I breast feed on my DMT? 
  7. Will I be able to be a good parent if I become disabled from my MS? 
  8. If I become disabled or unemployed as a result of MS will I be able to support my children? 
  9. What is the risk of my children getting MS? 
  10. Can I do anything to prevent them from getting MS? 
  11. Am I more likely to need an assisted delivery because I have MS? 
  12. Will I be able to have a normal vaginal delivery? 
  13. Will I be able to have an epidural during labour? 
  14. How you treat hyperemesis gravidarum during pregnancy? 
  15. Should I continue taking my other drugs for my MS symptoms during pregnancy? 
  16. What is the best treatment strategy for my MS? Should I go onto a DMT and get my MS under control before starting a family or should I first start my family? 
  17. What is the best treatment strategy for my MS to maximise my chances of having a family and keeping my MS under control? 
  18. How will having neutralizing anti-interferon beta antibodies affect my baby? 
  19. Can I have IVF? Will the drugs that are used to induce ovulation affect my MS? 
  20. What dose of vitamin D do you advise during pregnancy? 
  21. Are oral contraceptive safer for my MS? Which contraceptive do you recommend?
Borisow et al. Pregnancy in Multiple Sclerosis: A Questionnaire Study. PLoS One. 2014 ;9(6):e99106. doi: 10.1371/journal.pone.0099106. eCollection 2014.

BACKGROUND: MS preferentially affects females at childbearing age. For this reason MSers and treating physicians were frequently confronted with questions concerning family planning, pregnancy and birth.

OBJECTIVE: The aim of this study was to evaluate the expertise about pregnancy related topics in multiple sclerosis of neurologists in private practice.

METHODS: We developed a survey with 16 multiple choice questions about pregnancy related topics and sent it to neurologists in private practice in Berlin, Germany.

RESULTS: 56 completed questionnaires were sent back. 54% of all questions were answered correctly, 21% of the questions were answered with "I don't know". Correct answers were more often given by physicians who treat more than 400 MS patients per year (p = 0.001). Further positive associations were found for assumed relevance of the topic (p = 0.002) and the degree of counseling (p<0.001).

CONCLUSION: To provide a comprehensive counseling, MS patients with desire for children should be counselled by physicians with a lot of experience in MS treatment.

4 comments:

  1. I'm afraid neuros are the least expert of any medical specialism - the response to almost any question relating to MS is "dunno". As a woman I need to know, based on my MS, when I will hit the various EDSS point. If a neuro could give me a tailored answer (not the ridiculous ranges that are used) I could make a proper decision on whether I should have a baby. As ever with MS it falls on me. If only you people could come up with treatments that stop MS the MSers could plan for the future. All you seem to be interested in are experiments on mice or helping pharma companies undertake trials.

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    1. Re: "... If only you people could come up with treatments that stop MS."

      We have posted on several therapies on this blog that stop MS; NEDA and reduce end-organ damage. The ball is in your court, and your neurologists court, are you prepared to take the risks associated with these therapies?

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  2. Re: "....experiments on mice or helping pharma companies undertake trials."

    Most of the current DMTs have been translated via animal experiments, including mice. With regard to Pharma; unfortunately. they are the only show in town. If you want effective therapies with the correct level of evidence Pharma is the only route available for this. Believe me when I say we have tried to do this outside of Pharma and we can't. Clinical drug development is too expensive and risky and has too many regulatory requirements to be done in academia.

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