Recommendations of Multiple Sclerosis and Neuroimmunology Section of the Polish Neurological Society and the Polish Society of Gynecologists and Obstetricians for family planning and pregnancy management in women with multiple sclerosis: an update.

Abstract

Introduction: Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the Central Nervous System that most commonly affects females of reproductive age. Therefore, the issue of family planning is relevant in this population, especially in the context of starting and planning future disease modifying therapy (DMT), so that the risks to mother and child are minimized, while reproductive goals are met.

State of the art: Over the recent years the number of pregnancies in MS women has been increasing, as opposed to the trend in the general population. This is a result of several advancements in MS treatment and the growing body of evidence regarding DMT safety in the context of pregnancy and breastfeeding. It is not justified to delay DMT or to discourage patients from pregnancy planning. Instead, a highly individualized approach is recommended. The gynecological and obstetric approach to prenatal care and delivery should not differ from that offered to a general female population. Exclusive breastfeeding and early treatment reinitiation should be encouraged, with beta-interferons, glatiramer acetate and anti-CD20 monoclonal antibodies allowed in lactating women. Most DMTs require effective contraception and a pre-specified wash-out period before conception. On the other hand, beta-interferons, glatiramer acetate and dimethyl fumarate could be used until conception or even throughout pregnancy, as in the case of beta-interferons and glatiramer acetate. In females with highly active disease natalizumab could be continued until 34 gestational weeks, preferably every 6-8 weeks.

Clinical implications: Family planning for women with MS requires an informed multi-disciplinary counselling. Neurologists are typically not trained in contraceptive use and family planning, while gynecologists and obstetricians are not aware of the most recent advances in MS immunotherapy. The aim of this statement is to provide multidisciplinary guidance in pregnancy planning and MS management during pregnancy and post-partum.

Future directions: Family planning counselling should become part of routine MS care. Multidisciplinary approach is needed and should be encouraged with providing guidelines and educational resources to both, healthcare professionals and patients.