1Anwaar Mukhtar Bennour, 1Majda Elshukri, 1Naziha Amer, 1Heba Elzawawi, 1Rabha Elsahli, 1Abdelhamid Elzawawi
1Benghazi Medical Center, Benghazi, Libya
There are many misconceptions about multiple sclerosis (MS) and pregnancy with issues surrounding disease modifying therapies (DMTs) remains a regular subject of discussion.
To explore a local practice experience regarding management of women with MS during their family planning and pregnancy.
Material(s) and Method(s):
We reviewed the medical records of the patients registered in the MS clinic from the period 2016 till December 2019. Injectable interferonβ was the DMTs available to the patients. From the medical records we calculated the proportions of cases with planned and unplanned pregnancies and reviewed the disease course during pregnancy and after delivery. We also focus on the action plan taken regarding DMTs during or before pregnancy occur. This includes discontinuing vs maintaining DMTs, delivery methods, time of resumption of DMTs and breast feeding and getting magnetic resonance image (MRI) of the brain available before conception. Also we reviewed patients who refuses to conceive during their illness.
The total number of MS patients registered in the clinic is 360 patients, 169 (72%) were females, 40 (24%) were married. Twenty eight pregnancies were reported in 23 women. Their mean age is 37.9±2.7 (range 24-56) years. The duration of MS diagnosis is 10.2±5.5 (range 1-21) years with a median Expanded Disability Status Scale score (EDSS) of 1.6 ±2.0 (range 0.0-6.0). Thirteen (46.4%) pregnancies were unplanned whereas 15 (53.6%) were planned. All women (100%) with unplanned pregnancy stopped their DMTs when pregnancy was confirmed. All women (100%) with planned pregnancy stopped their DMTs 2-3 months prior to conception. Two (13.3%) patients conceived in the first quarter of 2019, advised and willing to continue their DMTs. Four women delivered by Caesarean section. The mean duration to resume DMTs is 11 (0-60) months after delivery. The median duration for breast feeding is 4 months. No patient has performed MRI of the brain prior to conception. Two patients prefer to avoid pregnancy because they are concerning about the care of the incoming child
This study reflects local practice protocol of women with MS during their pregnancy, addressing issues that are specific for women with MS. In order to make a good progress and to do better with women with MS, it is important to have guidance concerning prescribing decisions of DMTs in MS during all stages of family planning.