Patient awareness about family planning represents a major knowledge gap in multiple sclerosis
ECTRIMS Online Library. D'Hooghe M. 09/11/19; 279373; 21
Marie D'Hooghe
Marie D'Hooghe

Abstract: 21

Type: Hot Topic

Abstract Category: Hot Topic 2: MS Pregnancy in the treatment era

M. D'Hooghe1,2

1Neurology, Nationaal MS Centrum Melsbroek, Melsbroek, 2Center for Neurosciences, Vrije Universiteit Brussel, Brussel, Belgium

Taking into account the high prevalence of disease onset in adults between 20 and 40 years of age and the revised diagnostic criteria incorporating magnetic resonance imaging, the diagnosis of multiple sclerosis (MS) increasingly occurs at an early stage. Receiving this diagnosis with an unpredictable disease course frequently affects life choices including family planning. Dilemmas may arise as to the best timing of desired pregnancy, especially in view of the increasing awareness of considering early treatment. Current data to inform decisions on an individual basis are limited.
Women have MS about twice as often as men. Their increased risk of developing relapsing remitting disease during reproductive age appears to provide some protection against MS progression. While maternal MS is not associated with an increased risk to the fetus, increasing age and potent immunomodulatory treatments may have consequences on teratogenicity and pregnancy outcomes. Also, fertility treatments have been associated with an increased relapse risk, particularly if not resulting in pregnancy.
Reproductive concerns in women with MS relate to fertility, pregnancy, delivery, breastfeeding, relapse risk in the postpartum period and delay or discontinuation of disease modifying therapies. Women and men with MS are also frequently concerned about MS-related symptoms interfering with parenting, financial issues and the risk of multiple sclerosis for their children.
While not part of routine practice, genetic counseling to patients and their families was effective in increasing patients' knowledge of the etiology of MS and was viewed by patients as useful. A recent Danish study assessing knowledge about teratogenic risks of disease modifying therapies among patients uncovered a low level of knowledge in both sexes, being largely absent in male MS patients. About 10% of female MS patients reported having experienced an unplanned pregnancy while on MS treatment.
In conclusion, women and men with MS of reproductive age should be repeatedly asked about their reproductive plans. The timing of desired pregnancy and the need to prevent unintended pregnancies should be considered individually, allowing patients to make informed decisions. In an era of expanding treatment options with highly potent and potential teratogenic drugs, there is a compelling need to increase patient awareness and provide appropriate information about planning parenthood.
Disclosure: D´hooghe Marie: nothing to disclose

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