Family Planning Decision Making in People With Multiple Sclerosis

Abstract

Introduction: The majority of people diagnosed with MS are of childbearing or child fathering age, therefore family planning is an important issue for both women and men with MS. Fertility and the course of pregnancy are not affected by MS; however, people with MS (pwMS) may have concerns that there will be a greater risk of complications to the mother and/or adverse pregnancy outcomes either due to the disease or to ongoing medication. This survey aimed to understand family planning decision making in pwMS and related unmet educational needs.Methods: A total of 332 pwMS across the USA, UK, France, Germany, Italy, and Spain were recruited from a specialist patient panel agency to participate in a smartphone-enabled standing panel. The 80-question survey focussed on decision making and information sources for pwMS regarding family planning, as well as behavior during and after pregnancy. Male patients with MS did not respond to specific questions on pregnancy. Survey results were directly compared with the 2016 US and 2010 UN census data.Results: pwMS were more likely to have no children than the general population, particularly in the subgroup of patients aged 36–45 years. A total of 56% of pwMS reported that the disease affected, with different degrees of impact, their family planning decision making. Of these, 21% significantly changed their plans for timing of pregnancy and the number of children, and 14% decided against having children. Participants indicated that healthcare professionals were the primary source of information on family planning (81% of responses). The timing of planned pregnancy was not considered when selecting treatment by 78% of participants.Conclusion: MS was found to significantly impact family planning decision making, with pwMS significantly less likely to have children in comparison with the general population.

Fertility preferences and unmet need for family planning in women with multiple sclerosis

“…We found a high frequency of women who did not want to have children and had permanent contraception, which is in line with previous findings of a lower number of children in women with MS relative to the general population ( 3 , 8 ). Our findings also suggest that clinical variables such as MS phenotype and number of relapses are not significantly related to the decision to become a mother or not, as previously reported in the Portuguese population ( 8 ).…”

“…Women with MS report disease-related concerns in several areas that may influence their pregnancy desire. These can occur in relation to future offspring, such as the risk of inheriting MS ( 2 , 3 ), the risk of harm to the fetus or newborn/infant by exposure to disease-modifying therapies (DMTs) ( 3 , 4 ), and limitations in the ability to care for the children due to disability and MS symptoms ( 2 – 6 ). In relation to MS itself, the concerns described include the unpredictability of MS ( 4 , 7 , 8 ).…”

COVID-19 in the pregnant or postpartum MS patient: Symptoms and outcomes

“…( Collin et al, 2020 ) , ( Knight et al, 2020 ) , ( Zambrano et al, 2020 ) Women with MS are often of child-bearing age. Questions regarding the safety of becoming pregnant, ( Bonavita et al, 2021 ) including during the ongoing COVID-19 pandemic, ( Krysko et al, 2021 ) , ( Yam et al, 2020 ) have been raised. We queried the North-American COViMS Registry for reports of women with MS and COVID-19 who were pregnant or within 6 weeks postpartum.…”

The Rate of Hospitalization of Pregnant Women with Multiple Sclerosis in Poland

“…The latest reports published by Bonavita et al, revealed that people with MS more often than the general population do not have children, especially in the group of patients aged 36–45 years [ 1 ]. Moreover, in this study, 56% of respondents with MS reported that the disease to a varying degree influenced family planning decisions.…”

“…Nevertheless, it should be remembered that high disease activity may be one of the main reasons for not having children in MS patients. A total of 71.2% study participants believed that the symptoms of MS could disrupt parenting [ 1 ].…”