Attitudes to pregnancy in MSers living in North America

Pregnancy and MS; to start a family or not? #MSBlog #MSResearch

Alwan et al. Multiple Sclerosis and Pregnancy: A Comparison Study. Can J Neurol Sci. 2013 Jul;40:590-596.

Objective: To determine whether different healthcare systems may affect reproductive decision-making among MSers, we describe the reproductive practices and attitudes of Canadian MSers ascertained from the multidisciplinary MS Clinic at Hôpital Notre-Dame in Montreal, Quebec (NDMSC), in comparison to those of matched American self registrants from the database of the North American Research Committee on Multiple Sclerosis (NARCOMS). 

Methods: A total of 665 self-administered questionnaires on reproductive practices were sent out to eligible attendees attending the NDMSC. The short questionnaires were completed and returned to the authors in an anonymous format for analysis. 

Results: A total of 459 completed questionnaires were returned. The majority of NDMSC respondents (72.5%) and NARCOMS subset (75.2% females), did not encounter a pregnancy following diagnosis of MS. The most common MS-related reason for this decision was “symptoms interfering with parenting” (75.0% for the NDMSC, 72.6% for the NARCOMS). The most commonly reported non-MS-related reason was “a completed family” by the time of diagnosis in both the NDMSC and NARCOMS subset (58.0%, 40.4%, respectively). Concerns about financial issues both related and unrelated to MS were also commonly reported by males and females in both cohorts but significantly more so among the NARCOMS participants. 

Conclusion: These results indicate that reproductive decisions of MSers are highly affected by their illness and its associated disability, regardless of the available health care program. Health care providers should discuss their patients’ reproductive needs and perceptions to help them make more informed decisions.

“This study compared differences between Canadian and American MSers about their decisions to start, or not start, a family. Pregnancy and MS is a difficult subject. Decisions about whether to start or extend a family is not an easy one. Typically questions that are asked include the following: 1) What will pregnancy do to my MS?; 2) Will I be able to continue my treatments during pregnancy; 3) Will I be able to breastfeed?; 4) Will I be able to be cope with being a parent if I become disabled?; 5) What if become unemployed due to MS, will I be able to afford having a family; 6) What are the risks of my children getting MS?; 7) Can I do anything to reduce the chances of my children getting MS?; 8) What happens if my partner leaves me; will I be able to cope with MS and being a single parent?’; 9) I am already fatigued, will I be able to cope with the sleep deprivation of having a baby?”

“If you have any other questions please ask them. I will try and collate them and run a ‘Clinic Speak’ session on pregnancy to answer them.”

“To get an idea of issues related to pregnancy it would be helpful if you could complete the survey below. Thanks.”

Other relevant post on pregnancy on this blog:

02 Jun 2013
Objective: The analysis of perinatal results in pregnant women with multiple sclerosis (MS) and the assessment of the influence of pregnancy on this chronic disease in the population of pregnant women in our hospital in the 
02 May 2013
OBJECTIVES: The objectives of this research are to prospectively evaluate the prevalence of thyroid autoimmunity among MSers in relation to pregnancy, and to investigate its impact on pregnancy outcome, postpartum 
09 Mar 2013
“I am often asked what topics are neglected in MS research, that are very important for MSers? Pregnancy is one of these areas. Therefore it is very appropriate that ECTRIMS has just sponsored a focused workshop on this 
11 Mar 2013
“As you are aware pregnancy affects the natural history of MS; what are the mechanisms that underlie these effects? If we can define them we may be able to mimic a state of pregnancy, i.e. pseudopregnancy, and use this to 
12 Jan 2013
Pregnancy & MS: birth hospitalisation for MSers is no different to anybody else. #MSBlog: For female MSers; MS affect on the outcome of birth for both you and your baby. Epub: Lu et al. On behalf of the British Columbia 
25 Oct 2012
METHODS: They recruited MSers, prospectively followed-up in 21 Italian MS Centres, for whom a pregnancy was recorded in the period 2002–2008. MSers were divided into 2 groups: drug-exposed pregnancies (EP: 
14 Apr 2012
The investigators reviewed medical records and used a structured questionnaire to investigate gravidity (number of pregnancies), parity (number of births), and the number of relapses during the 2 years before pregnancy, 
14 Aug 2012
Conclusion: Although the course of MS was deteriorated 3 months after delivery, it was not statistically significant comparing annual relapsing rates during the years prior to pregnancy. Moreover, the rate of disease 
15 Nov 2012
This has been hypothesised to be related to maternal vitamin D levels during pregnancy, although conclusive evidence to support this is lacking. To date, no large studies of latitudinal variation in the month of birth effect have 
16 Jul 2011
“Because of this study, and the fact that pregnancy itself reduces the attack rate, researcher’s have been trying to find out what it is about pregnancy that is so beneficial for MS’ers.” “We assume that the profound changes that 
28 Jul 2011
Methods: In 2001, 35,794 mothers of participants of the Nurses’ Health Study II completed a questionnaire inquiring about their experiences and diet during pregnancy with their nurse daughters. This allowed these 
31 May 2011
Of the women exposed to natalizumab during pregnancy, 29 women gave birth to 28 healthy children; one child was born with hexadactyly (an extra finger), 5 pregnancies ended in an early miscarriage and one woman 
15 Jul 2011
The average or mean rate of relapse was 0.7 per year in the year before pregnancy, 0.5 during the first trimester, 0.6 during the second trimester and 0.2 during the third. The rate increased to 1.2 during the first three months 
16 Sep 2011
21/101 (21%) of births to MS women treated with DMD prior to pregnancy were exposed to a DMD. In all cases, exposure was documented as unintentional and DMD treatment was stopped within 2 months of gestation.
05 Jun 2012
RESULTS: From the total group of patients, 89 pregnancies occurred without any exposure to MS drugs, while 61 pregnancies occurred with at least eight weeks of exposure to MS immunomodulatory drugs. The rate of 
20 Dec 2010
A report on 88 pregnancies in Italian woman that were exposed to interferon-beta (average exposure 4 to 5 weeks) has demonstrated that exposure to interferon-beta was not associated with an increased risk of spontaneous 
06 Jan 2013
METHODS: In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women MSers regularly followed-up in 21 Italian MS 
27 May 2012
Objective: Pregnancy has a well documented effect on relapse risk in MS. Prospective studies have reported a significant decline by two-thirds in the rate of relapses during the third trimester of pregnancy and a significant 
19 Sep 2011
Natalizumab did not affect the ability of treated males to produce pregnancies in untreated females. In female guinea pigs, no treatment-related changes were seen in uterine weights or ovary weights. Pregnancy rates were 
05 Aug 2011
“Why does MS go away during pregnancy?”. Your baby is made up of features from Mum and Dad. The bits from dad should be rejected by the mum’s immune system, just as a organ transplant would be, as they are foreign to 
16 Jul 2012
Of the 20.9% of participants who decided to become pregnant (or father a pregnancy) following a diagnosis of MS, 49.5% had two or more pregnancies. Conclusion:This study indicates that an MS diagnosis does not 
13 Jul 2011
The only significant predictor of having a relapse after childbirth was an increased number of relapses in the year before pregnancy and during the pregnancy itself. Therefore, the reported association between breastfeeding 
28 Oct 2012
However, the topic is important and if we want to provide holistic care for woman with MS we need to address how we handle the issue of pregnancy and the advice we give. Misinformation or inconsistent information is one 
11 Oct 2012
To investigate if women with multiple sclerosis (MS) experience changes in MS symptoms related to pregnancy, the postpartum period, menopause or use of oral contraception (OC) or postmenopausal hormone therapy (HT).

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

1 comment

  • So sad as this vile disease spoils what should be one of life's greatest events. Really time you guys nailed this disease once and for all.

By Prof G



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