New guidelines for pregnancy care in multiple sclerosis, drawn up by a panel of UK experts, have been published this week.
They aim to reduce uncertainty about treatments that are safe and appropriate for pregnant and breastfeeding women with MS, and for couples affected by MS who are planning a pregnancy.
MS is usually diagnosed among 20-40 year olds, two thirds of whom are women. Around this age, both men and women might be planning to have children. At the same time, it is becoming increasingly clear that disease modifying drugs (DMDs) should be started as early as possible. Delaying DMD treatment until after having a family can lead to irreversible disability in the long term. For this reason, it makes sense to start discussing family planning and pregnancy early after diagnosis, alongside discussions about DMDs, if appropriate.
However, there is limited evidence available to guide these discussions, and so the MS Trust and a group of very experienced health professionals set out to develop a set of consensus guidelines to bring clarity to this area. The guidelines have been endorsed by the Association of British Neurologists, and have been reviewed by a panel of MS specialist nurses, neurologists, obstetricians, midwives and people with MS as part of the development process.
The guidelines bring together evidence from drug specific pregnancy registers as well as published peer reviewed research. They cover pre-pregnancy counselling and DMDs for men and women, MS management during pregnancy, delivery and anaesthetic options. The guidelines also give advice for the period after birth, for breastfeeding and for the use of DMDs after the birth.