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Considering the complete patient when talking about family planning
Learning objectives
This module was produced during the 2020 quarantine, where filming has been conducted remotely to adhere to social distancing guidelines. For this reason, please forgive a lower production quality than you are used to seeing from us.This module is intended to help you:
- Be aware of topics that should be covered when discussing family planning with patients
- Understand how MS and its symptoms can affect pregnancy, and vice versa
- Consider how treatment should be managed in people with MS who wish to conceive
Case study of a patient with MS planning to get pregnant
Zoe
- Age: 32 years
- Occupation: Teacher
Current medication
- High-efficacy therapy
- Anticonvulsants
Previous clinical history
- 3 years ago: Diagnosed with relapsing–remitting MS; treatment with platform therapy
- 14 months ago: Experienced a major relapse with persistent seizures; started current medication
Persistent symptoms
- Weakness and reduced sensation in upper legs and pelvic area
Patient case is fictional and derived from the expert’s clinical experience.
Zoe would like to start a family. What should the MS care team discuss with her at this point?
Select the correct answer(s)
- Coyle PK, et al. Mult Scler Relat Disord. 2019;32:54–63.
- Dobson R, et al. Pract Neurol. 2019;19:106–14.
- Vukusic S, et al. Nat Rev Neurol. 2015;11:280–9.
- Langer-Gould AM. Continuum (Minneap Minn). 2019;25:773–92.
- Canibaño B, et al. J Drug Assess. 2020;9:20–36.
Case study of a patient with MS planning to get pregnant
Zoe
- Age: 32 years
- Occupation: Teacher
Current medication
- High-efficacy therapy
- Anticonvulsants
Previous clinical history
- 3 years ago: Diagnosed with relapsing–remitting MS; treatment with platform therapy
- 14 months ago: Experienced a major relapse with persistent seizures; started current medication
Persistent symptoms
- Weakness and reduced sensation in upper legs and pelvic area
Patient case is fictional and derived from the expert’s clinical experience.
What would you tell Zoe in order to alleviate any concerns she might have about becoming pregnant?
Select the correct answer(s)
DMT, disease-modifying therapy
According to a large registry study, pregnancy may delay disability progression 4
- Dobson R, et al. Pract Neurol. 2019;19:106–14.
- McKay KA, et al. Neurotoxicology. 2017;61:189–212.
- Langer-Gould AM. Continuum (Minneap Minn). 2019;25:773–92.
- Masera S, et al. Mult Scler. 2015;21:1291–7.
- Coyle PK, Oh J, Magyari M, Oreja-Guevara C, Houtchens M. Management strategies for female patients of reproductive potential with multiple sclerosis: An evidence-based review. Mult Scler Relat Disord. 2019;32:54–63.
- Fragoso YD, Adoni T, Brooks JBBB, Finkelsztejn A, da Gama PD, Grzesiuk AK, et al. Practical evidence-based recommendations for patients with multiple sclerosis who want to have children. Neurol Ther. 2018;7:207–32.
- Dobson R, Dassan P, Roberts M, Giovannoni G, Nelson-Piercy C, Brex PA. UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines. Pract Neurol. 2019;19:106–14.
- Amato MP, Bertolotto A, Brunelli R, Cavalla P, Goretti B, Marrosu MG, et al. Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach. Neurol Sci. 2017;38:1849–58.
- Smith AL, Cohen JA, Ontaneda D, Rensel M. Pregnancy and multiple sclerosis: Risk of unplanned pregnancy and drug exposure in utero. Mult Scler J Exp Transl Clin. 2019;5:205521731989174.
- Vukusic S, Marignier R. Multiple sclerosis and pregnancy in the “treatment era”. Nat Rev Neurol. 2015;11:280–9.
- Langer-Gould AM. Pregnancy and family planning in multiple sclerosis. Continuum (Minneap Minn). 2019;25:773–92.
- Canibaño B, Deleu D, Mesraoua B, Melikyan G, Ibrahim F, Hanssens Y. Pregnancy-related issues in women with multiple sclerosis: an evidence
- Multiple Sclerosis Trust. Risk of developing MS. 2018. https://www.mstrust.org.uk/a-z/risk-developing-ms. Accessed November 2020.
- Finkelsztejn A, Brooks JBB, Paschoal FM, Fragoso YD. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature. BJOG. 2011;118:790–7.
- Bove R, Alwan S, Friedman JM, Hellwig K, Houtchens M, Koren G, et al. Management of multiple sclerosis during pregnancy and the reproductive years. Obstet Gynecol. 2014;124:1157–68.
- Nair RR, Verma P, Singh K. Immune-endocrine crosstalk during pregnancy. Gen Comp Endocrinol. 2017;242:18–23.
- Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. N Engl J Med. 1998;339:285–91.
- McKay KA, Jahanfar S, Duggan T, Tkachuk S, Tremlett H. Factors associated with onset, relapses or progression in multiple sclerosis: A systematic review. Neurotoxicology. 2017;61:189–212.
- Landi D, Ragonese P, Prosperini L, Nociti V, Haggiag S, Cortese A, et al. Abortion induces reactivation of inflammation in relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry. 2018;89:1272–8.
- Barry B, Erwin AA, Stevens J, Tornatore C. Fingolimod rebound: A review of the clinical experience and management considerations. Neurol Ther. 2019;8:241–50.
- Hughes SE, Spelman T, Gray OM, Boz C, Trojano M, Lugaresi A, et al. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler. 2013;20:739–46.
- Portaccio E, Ghezzi A, Hakiki B, Sturchio A, Martinelli V, Moiola L, et al. Postpartum relapses increase the risk of disability progression in multiple sclerosis: The role of disease modifying drugs. J Neurol Neurosurg Psychiatry. 2014;85:846–51.
- Vukusic S, Hutchinson M, Hours M, Moreau T, Cortinovis-Tourniaire P, Adeleine P, et al. Pregnancy and multiple sclerosis (the PRIMS study): Clinical predictors of post-partum relapse. Brain. 2004;127:1353–60.
- Langer-Gould A, Smith JB, Albers KB, Xiang AH, Wu J, Kerezsi EH, et al. Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort. Neurology. 2020;94:e1939–49.
- Bsteh G, Algrang L, Hegen H, Auer M, Wurth S, Di Pauli F, et al. Pregnancy and multiple sclerosis in the DMT era: A cohort study in Western Austria. Mult Scler. 2020;26:69–78.
- Masera S, Cavalla P, Prosperini L, Mattioda A, Mancinelli C, Superti G, et al. Parity is associated with a longer time to reach irreversible disability milestones in women with multiple sclerosis. Mult Scler. 2015;21:1291–7.
- De Giglio L, Federici S, Ruggieri S, Borriello G, D’Errico M, De Angelis C, et al. Cesarean section in women with MS: A choice or a need? Mult Scler Relat Disord. 2020;38:101867.
- Krysko KM, Graves JS, Dobson R, Altintas A, Amato MP, Bernard J, et al. Sex effects across the lifespan in women with multiple sclerosis. Ther Adv Neurol Disord. 2020;13: 1756286420936166.
- Montalban X, Gold R, Thompson AJ, Otero-Romero S, Amato MP, Chandraratna D, et al. ECTRIMS/EAN Guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler. 2018;24:96–120.
- Krysko KM, Rutatangwa A, Graves J, Lazar A, Waubant E. Association between breastfeeding and postpartum multiple sclerosis relapses: A systematic review and meta-analysis. JAMA Neurol. 2019;77:327–38.
Which topics should be discussed with all patients with MS who can get pregnant?
Select the correct answer(s)
DMT, disease-modifying therapy
- Coyle PK, et al. Mult Scler Relat Disord. 2019;32:54–63.
- Dobson R, et al. Pract Neurol. 2019;19:106–14.
- Amato MP, et al. Neurol Sci. 2017;38:1849–58.
- Vukusic S, et al. Nat Rev Neurol. 2015;11:280–9.
Select the correct statement(s)
If a patient on DMT decides to try for a baby, the safety of the treatment in pregnancy should be balanced with the patient’s risk of relapse. Patients with highly active disease may require continuation of treatment or initiation of a bridging treatment.
DMT, disease-modifying therapy
- Langer-Gould AM. Continuum (Minneap Minn). 2019;25:773–92.
- Montalban X, et al. Mult Scler. 2018;24:96–120.
- Krysko KM, et al. Ther Adv Neurol Disord. 2020;13:1756286420936166.
- Vukusic S, et al. Nat Rev Neurol. 2015;11:280–9.
What factors are correlated with an increased risk of postpartum relapse?
Select the correct answer(s)
- Canibaño B, et al. J Drug Assess. 2020;9:20–36.
- Vukusic S, et al. Brain. 2004;127:1353–60.
- Langer-Gould A, et al. Neurology. 2020;94:e1939–49.
- Hughes SE, et al. Mult Scler. 2013;20:739–46.
- Portaccio E, et al. J Neurol Neurosurg Psychiatry. 2014;85:846–51.
Select the correct statement(s)
Recent recommendations emphasise that most women with MS should be encouraged to breastfeed. In women with particularly active disease, the use of certain DMTs, like injectable therapies or monoclonal antibody therapies, may be considered to prevent relapses.
DMT, disease-modifying therapy
- Dobson R, et al. Pract Neurol. 2019;19:106–14.
- Langer-Gould AM. Continuum (Minneap Minn). 2019;25:773–92.
- Krysko KM, et al. JAMA Neurol. 2019;77:327–38.
- Krysko KM, et al. Ther Adv Neurol Disord. 2020;13:1756286420936166.
Congratulations!
You have completed module 5
Considering the complete patient when talking about family planning
Multiple sclerosis is a condition that predominantly affects women of reproductive age. The ability to have a baby is a common concern among patients with MS. This module discusses how patients may be counselled and managed before, during and after pregnancy.
Length
10 min course
Job code
NPS-TPE-NP-00172
