Wednesday, 3 December 2014

ClinicSpeak: Management of Pregnancy in MSers

Are you a woman with MS? The following post is for you. #MSBlog #MSResearch #ClinicSpeak

"The meta-analysis below adds little to the issues we as MSologists need to address on a daily basis when we manage woman with MS wanting start, or extend, their families. The following is a list of questions I pose when I give my usual talk on pregnancy and fertility MS to young trainees or other neurologists. If you are a woman with MS have you been provided with answers to all of these? I have covered most of  these topics in the past on the blog."
  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? 
  17. Should I go onto a DMT and get my MS under control before starting a family or should I first start my family? 
  18. What is the best treatment strategy for my MS to maximise my chances of having a family and keeping my MS under control? 
  19. How will having neutralizing anti-interferon beta antibodies affect my baby? 
  20. Can I have IVF? 
  21. Will the drugs that are used to induce ovulation affect my MS? 
  22. What dose of vitamin D do you advise during pregnancy? 
  23. Are oral contraceptive safer for my MS? 
  24. Which contraceptive do you recommend?

Bove et al. Management of Multiple Sclerosis During Pregnancy and the Reproductive Years: A Systematic Review. Obstet Gynecol. 2014;124(6):1157-1168.

OBJECTIVE: To examine the evidence guiding management of multiple sclerosis (MS) in reproductive-aged women.

METHODS OF STUDY SELECTION: Two reviewers categorized all studies identified in the search by management topic, including effect of pregnancy on MS course, foetal risks associated with disease-modifying treatments during pregnancy, and management of patients off disease-modifying treatment. We categorized studies by strength of evidence and included prior meta-analyses and systematic studies. These studies were then summarized and discussed by an expert multidisciplinary team.

RESULTS: The risk of MS relapses is decreased during pregnancy and increased postpartum. Data are lacking regarding the risks of disease-modifying treatments during pregnancy. There may be an increased risk of MS relapses after use of assisted reproductive techniques. There does not appear to be a major increase in adverse outcomes in newborns of mothers with MS.

CONCLUSION: Although there are many unmet research needs, the reviewed data support the conclusion that in the majority of cases, women with MS can safely choose to become pregnant, give birth, and breastfeed children. Clinical management should be individualized to optimize both the mother's reproductive outcomes and MS course.

2 comments:

  1. This has been a tough one for me. After I was diagnosed, I was told that I should get pregnant as soon as possible or get on a DMD and go back to using contraception. Since I'd already been trying to get pregnant for four years, that wasn't very helpful. Eventually, after my own research, I made the decision to use Copaxone and still try to conceive. It felt gut wrenching having to decide what to do about that. Still not pregnant. Been on Copaxone for 18 months now.

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    Replies
    1. Careful Rachel, Teva will be marketing Copaxone as a contraceptive next! Hope you get your wish soon.
      MD2

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