Consensus guidelines reached regarding pregnancy and MS

A set of guidelines on multiple sclerosis (MS) and pregnancy have been produced for the UK, supported by the Association of British Neurologists. The first of their kind, the guidance covers all elements of care related to pregnancy for those living with MS, from pre-pregnancy support to management of medication during pregnancy, birth-related guidance and postpartum advice.It is common for women to be diagnosed with MS in early adulthood before they have begun, or completed, their family. However, until now there has been insufficient evidence to support much needed discussions around family planning and management of their MS and pregnancy simultaneously.This invaluable guidance provides the information needed for clinicians to have informed discussions and for patients to make informed decisions about their lives, their families and their MS.[caption id="attachment_3775" align="alignnone" width="1280"] Fig 1: Infographic summarising the topics to consider across agreed core areas[/caption]

Key points to take from the guidance include:

• Treatment with disease-modifying drugs should not be delayed until a woman with multiple sclerosis (MS) has completed her family.
• Consider the possibility of pregnancy when prescribing to all women with MS of childbearing age.
• Relapse rate reduces naturally during pregnancy, and so many women with MS choose to stop disease-modifying drugs when they become pregnant—however, for those with very active MS, treatment throughout pregnancy should be considered.
• If relapse occurs, corticosteroids can be given during pregnancy and while breastfeeding.
• Having MS does not automatically make pregnancy high risk and should not in itself limit birthing options.

[caption id="attachment_3776" align="alignnone" width="950"] Fig 2: Infographic outlining disease-modifying treatments whilst pregnant and breastfeeding[/caption]In addition to the valuable evidence that this work brings together, the steering group responsible calls for establishment of an MS-pregnancy register to ensure meaningful data collation and learning can begin from here onwards. They also recommend the creation of joint neuro-obstetric clinics to optimally manage people with MS for the duration of their pregnancy and post-partum journey.

Really happy to see this in print - lots of work to attempt to reach a meaningful consensus. Hopefully useful for both clinicians and patients @BartsMSBlog @GavinGiovannoni @nelson_piercy @PoojaDassan @MSTrust @mssocietyuk https://t.co/cyUsowFG0u

— Ruth Dobson (@drruthdobson) 6 January 2019

For more information

• Read the guidance here or download as pdf file.
• View the infographics covering the key topics for consideration and outlining DMT use during pregnancy and breastfeeding.