Exploring Patients’ Knowledge and Misconceptions about Multiple Sclerosis and Pregnancy

Abstract

Multiple sclerosis (MS) is a lifelong neurologic disease affecting the central nervous system and resulting in demyelination and axonal loss over time. Symptoms are widely variable and often involve motor and sensory impairment, vision loss, gait disturbance, cognitive dysfunction, and fatigue. Furthermore, MS is a disease common to women of childbearing age, with 70% of patients being women and with 90% of patients presenting between the ages of 15 and 50.1 Family planning must be taken into account at time of diagnosis and when discussing which disease modifying agent to employ. Accurate knowledge and understanding of family planning issues is important for best outcomes.The relationship between pregnancy and relapse outcomes is complex and Education about peripartum concerns is also paramount. In a study of 461 women with MS, there was a higher rate of caesarian section; however, these findings represented a concurrently higher rate of planned, rather than emergency, caesarian sections, 5 a finding that might reflect an overly cautious approach. Previous practice advocated for caesarian sections to avoid pelvic floor trauma and thus exacerbation of preexisting urinary frequency and bladder control issues; however, it was shown in a study of 273 women in 2006 that urinary incontinence postpartum was more related to duration and severity of MS and not method of delivery. AbstractMultiple sclerosis (MS) has a high incidence in women of childbearing age. Accurate understanding of family planning matters is crucial for best outcomes. Methods: Thirty-seven women with MS aged 18 to 50 completed an anonymous questionnaire at an MS Center in New York City. There were 22 questions pertaining to four main categories: effect of pregnancy on MS, effect of MS on pregnancy, MS medication safety during pregnancy and breastfeeding, and effect of MS on offspring. Results: Mean age of patients was 36 years (standard deviation [SD] ±5.6); 86% had relapsing-remitting (RRMS). Mean time since diagnosis was 6.7 years (SD±5.2); 30.6% had been pregnant since diagnosis. Average correct score was 32.8% (SD±20.3), and while higher in patients who had been pregnant since diagnosis, 40.5% (SD±24.7) versus 31.3% (SD±17.9), there was no statistically significant difference; p=0.21. Largest knowledge deficit pertained to effect of MS on reproduction: average score 27.7% (SD±10.1). Only 21.0% knew that relapses can be treated with steroids during pregnancy; 50.0% of those with prior pregnancy knew this fact. Thirtyfour percent of patients on disease-modifying therapies (DMTs) reported not consistently using birth control. Conclusions: Our data identified misconceptions on important reproductive topics. It is important that providers educate effectively their patients on matters of reproduction.

Family Planning for People with Multiple Sclerosis in Saudi Arabia: an Expert Consensus

“…But, there is evidence, including in women from the Middle East, that the presence of MS leads women to avoid pregnancy (perhaps completely), due to fears or concerns about the effect of MS on their general health, the adverse effects of MS treatments on the pregnancy or on their fertility, and possible limitations of the use of fertility treatments once MS has been diagnosed [ 4 , 5 ]. Misconceptions about MS and pregnancy were common among a sample of patients in the USA [ 6 ]. Women with MS, and their partners, have the same right to pursue family life as anyone else and should be encouraged to do so [ 1 ].…”