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

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.

Automated summary

The objective of this study was to develop evidence-based recommendations on pregnancy management for persons with multiple sclerosis (MS). A total of 104 proposed recommendations were reached through a thorough review of literature and expert consensus. These recommendations cover various aspects including pregnancy planning, follow-up, delivery routes, anesthesia, prevention of relapses, breastfeeding, vaccinations, etc. These recommendations are expected to harmonize counseling and treatment practices, and provide better and individualized choices for individuals with MS.