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Dr Maria K. Houtchens: Family Planning with MS - General Considerations
In this session, Assistant Professor Houtchens speaks about family planning issues in women with MS. She commented that there are currently 13 medications available in the United States to treat MS; some are safe to use and some are known teratogens.
Assistant Prof Houtchens highlights an unmet medical need—which is that neurologists do not receive specific training and hence may lack the necessary skills counsel their MS patients on when to become pregnant. It is important to determine when disease is stable enough to start reproductive efforts. Thus, Neurologists should educate themselves so that they can give guidance to their patients on getting pregnant, managing pregnancy, and in giving birth.
Unfortunately, there are no guidelines in the US or the EU to aid in family planning in women with MS. Thus, Assistant Prof Houtchens makes recommendations based on her clinic’s experience and a few publications. There is no data on large populations to make strong (Category 1) guideline recommendations, but a study done in the early 1990s (prior to MS medications being available) looked at pregnancy outcomes. Specifically, investigators assessed the risk of relapse during both pregnancy and post-partum. Results showed that MS patients in their second and third trimesters showed a 50% or more decrease in risk of relapse as pregnancy progressed. Following birth however, about 30% of patients relapsed and the frequency of relapse doubled in the first 3-6 months.
The available data shows that the risk of a relapse is highest following birth in a woman who had a relapse within the 12-month period prior to getting pregnant. Assistant Prof Houtchens thus recommends that if possible, MS events should be assessed along with MRI activity during the 12 months prior to pregnancy and medications should be considered during the post-partum period.
The interview was recorded at the annual ECTRIMS meeting from 14-17 September 2016 in London, United Kingdom.
Dr Maria K Houtchens, MD, Assistant Professor of Neurology, Brigham and Women’s Hospital, Massachusetts, USA