Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society

Abstract

Objective: The objective of this study was to develop evidence-based recommendations on pregnancy management for persons with multiple sclerosis (MS). Background: MS typically affects young women in their childbearing years. Increasing evidence is available to inform questions raised by MS patients and health professionals about pregnancy issues. Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and university databases (January 1975 through June 2021). The RAND/UCLA appropriateness method was developed to synthesise the scientific literature and expert opinions on healthcare topics; it was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence. Results: A strong agreement was reached for all 104 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, locoregional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses and disease-modifying treatments. Conclusion: The 2022 recommendations of the French MS society should be helpful to harmonise counselling and treatment practice for pregnancy in persons with MS, allowing for better and individualised choices.

The Response Study: A French registry on pregnancy in women with MS and related disorders and their children up to 6 years—Protocol, recruitment status, and baseline characteristics

“…On the other hand, after an exhaustive review of the international literature, the French MS Society (SFSEP) concludes in its 2022 recommendations that the obstetric follow-up recommended in the general population should be carried out in MS women. 25…”

“…On the other hand, after an exhaustive review of the international literature, the French MS Society (SFSEP) concludes in its 2022 recommendations that the obstetric follow-up recommended in the general population should be carried out in MS women. 25 RESPONSE will also provide information on the management of DMTs by French neurologists in the context of pregnancy. In our first data collected between August 2019 and April 2023, the proportion of women who never received a DMT was only 15%, a figure much lower than older series from the literature.…”

Pregnancy-related healthcare utilization among women with multiple sclerosis

“…Regarding the MS follow-up, in 26.9% of pregnancies, women did not have any visit to a neurologist during pregnancy and within the 12 months after pregnancy. This finding is surprising because this consultation is useful to evaluate the postpartum period and to determine whether and when a DMT should be initiated ( 38 , 39 ) or whether breastfeeding is possible. However, it is also possible to prepare for the postpartum period during the prepartum period ( 40 ).…”

The protective role of breastfeeding in multiple sclerosis: Latest evidence and practical considerations

“…Therefore, EMA and FDA recommend high caution for adverse effects in infants if its use is unavoidable in the lactating mother. Nevertheless, different guidelines ( 53 , 54 ) suggest the resumption of anti-CD20 therapies, if needed, after the first weeks of breastfeeding. Vaccinations, which are contraindicated in breastfeeding women, but needed for anti-CD20 therapies, may be discussed with patients.…”