The road to conception for women with multiple sclerosis

Abstract

Objective The objective of this prospective “real world” study is to gain insight into the different “roads to conception” that women with MS take as part of the prospective Canadian Multiple Sclerosis Pregnancy Study (CANPREG-MS). Methods Participants are women with MS who are planning a pregnancy. Data cut-off for analyses was April 30, 2020. Results We believe this is the first prospective National study of women with MS planning pregnancies. The data are for the first 44 women enrolled of whom 26 achieved pregnancy by cut-off date. Seven women used assisted reproductive technologies (ARTs); 6 stopped disease modifying therapy (DMT) against their neurologists’ recommendations; 6 had an interruption(s) in trying to conceive due to MS relapses, MRI-detected inflammation, or limited “windows of opportunity” between DMT courses. Conclusion The study illustrates the roads that women take to conception, even if they are on the same therapy and have similar clinical expression of MS. Advice given by treating neurologists on washout periods show discrepancies. This paper highlights the real problem that there is no definitive, international consensus on managing these women due to the lack of “real world” data and thus the goal of CANPREG-MS is to provide such real world data.

The Canadian Multiple Sclerosis Pregnancy Study: First-trimester miscarriages in women with multiple sclerosis

“…DMTs discussed here are referred to using generic names as well as trade names to reflect the information conveyed by participants, as we have done previously. 12 Physician information provided to the study used trade names, generic names, or both. We did not find any discrepancies between the patient information and that of the neurologist with respect to any specific DMT usage.…”

“…It is acknowledged that participants who initially enrolled as "planning" in CANPREG-MS tend to notify study personnel very early if a menstrual cycle is missed. 12 Descriptive statistics were provided to describe the study participants (median, average, and standard deviation (SD) for continuous variables and percentages for categorical variables). The prevalence of RPL was defined as the number of all CANPREG-MS participants who had three or more miscarriages.…”

“…Women enrolled as planning are recontacted on a regular basis for updates. 12 Telephone interviews are conducted using standardized questionnaires.…”

“…It is acknowledged that participants who initially enrolled as “planning” in CANPREG-MS tend to notify study personnel very early if a menstrual cycle is missed. 12…”

Optimizing the “Time to pregnancy” in women with multiple sclerosis: the OPTIMUS Delphi survey

“…Indeed, nowadays, such an attitude seems outdated. In addition, recommendations about DMD use vary considerably (37,38). Recently, various attempts have been made to resume the main counseling issues and related management options for MS women with reproductive desires (39)(40)(41)(42)(43).…”