Development of a combined Multiple Sclerosis and Maternal Medicine Service

Introduction

Multiple Sclerosis (MS) is the commonest cause of disability in young adults. It commonly affects women more than men and is most diagnosed at a child-bearing age (20-45 years of age); hence the majority of patients will not have completed their families at diagnosis¹.

Increasing evidence suggests that delaying the start of disease-modifying treatment until women or men have completed their families may lead to irreversible disability^1,2. The wide range and complexity of available DMTs including the increased use of AHCT poses significant challenges for MS specialists in the management of MS in young adults^2-4.

Having a better understanding of the effects of pregnancy and DMTs on MS is associated with improved family planning counselling for women and men⁴. Close collaboration with the Obstetric Maternal Medicine Team is essential to provide high quality care for the clinical management and follow up of patients.

Objectives:

• The main objectives of a combined MS-Maternal Medicine service at Sheffield Teaching Hospitals include:
• To encourage and facilitate family planning discussion (pre-conception counselling).
• Develop a comprehensive plan of management during pregnancy and labour.
• Develop a comprehensive management plan and advice for the immediate post-partum period.

Service Development

1. The concept of the combined MS-Maternal Medicine clinic was explored and discussed with members of the multi-disciplinary team (MDT) including MS Consultants, MS nurses and the Obstetric consultants with specialist interest in Maternal medicine.
2. A quarterly pre-conception clinic will be offered to all MS patients planning for pregnancy. This clinic will offer in-depth pre-conception counselling (including fertility preservation for patients planned for AHSCT)) by the MS consultant, Obstetric consultant, MS specialist Nurse and AHSCT Nurse.
3. A monthly clinic ( 3 slots) will be offered to review patients who are pregnant jointly with the obstetric team ( a joint virtual antenatal clinic ).
4. A patient pathway proforma will be used during the appointment to guide discussions.
5. A patient satisfaction questionnaire will be developed to obtain patient feedback.

Results

• This service is currently in development and appointments will be offered to patients in May 2021.

• The aim of this service is to provide a high quality service for both men and women with MS to plan their families and experience the journey through pregnancy safely whilst providing the best care for their underlying MS .

Conclusions

We will provide updates once the service is launched and collect data for a service evaluation.

Figure 1: Multiple Sclerosis – age distribution of new cases of MS and GP registered population by sex (financial years April 2012 to March 2017 for new cases, 2017 for registered population, England) ⁵

Figure 2: Expected flowchart of the new service.

References:

1. Dobson R, Dassan P, Roberts M, et al UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines Practical Neurology 2019;19:106-114.
2. Voskuhl R., Momtazee C. Pregnancy: Effect on Multiple Sclerosis, Treatment Considerations, and Breastfeeding. Neurotherapeutics.
3. lwan S., Yee I., Dybalski M., Guimond C., Dwosh E., Greenwood T., Butler R., Sadovnick A. Reproductive decision making after the diagnosis of multiple sclerosis (MS) Mult. Scler. J. 2013;19:351–358.
4. Coyle P.K., 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. doi: 10.1016/j.msard.2019.04.003.
5. The PHE Neurology Dementia Intelligence team using The Health Improvement Network (THIN)