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Multiple Sclerosis and Pregnancy: A Comparison Study

Published online by Cambridge University Press:  23 September 2014

Sura Alwan ,
Magdalena Dybalski ,
Irene M. Yee ,
Talitha M. Greenwood ,
Elaine Roger ,
Nancy Nadeau ,
Pierre Duquette  and
A. Dessa Sadovnick
Sura Alwan
Affiliation:
Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia
Magdalena Dybalski
Affiliation:
Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
Irene M. Yee
Affiliation:
Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
Talitha M. Greenwood
Affiliation:
Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
Elaine Roger
Affiliation:
Faculty of Medicine, University of Montreal
Nancy Nadeau
Affiliation:
Faculty of Medicine, University of Montreal Multiple Sclerosis Clinic, Hôpital Notre Dame du CHUM, Montreal, Quebec, Canada
Pierre Duquette
Affiliation:
Faculty of Medicine, University of Montreal Multiple Sclerosis Clinic, Hôpital Notre Dame du CHUM, Montreal, Quebec, Canada
A. Dessa Sadovnick*
Affiliation:
Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
*
University of British Columbia, Vancouver Coastal Health Authority - UBC Hospital, S113-2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada. Email: [email protected]
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Abstract:

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Objective:

To determine whether different health care systems may affect reproductive decision-making among patients with Multiple Sclerosis (MS), we describe the reproductive practices and attitudes of Canadian MS patients ascertained from the multidisciplinary MS Clinic at Hôpital Notre-Dame in Montreal, Quebec (NDMSC), in comparison to those of matched American selfregistrants 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 MS patients 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.

Résumé:

RÉsumÉ: Objectif:

Le but de l'étude était de déterminer si différents systèmes de santé peuvent influencer le processus de décision concernant la reproduction chez les patient(e)s atteint(e)s de sclérose en plaques (SP). Nous décrivons les pratiques et les attitudes concernant la reproduction des patient(e)s canadien(ne)s atteint(e)s de SP fréquentant une clinique multidisciplinaire de SP à l'Hôpital Notre-Dame, à Montréal, au Québec (CSPND) et nous les avons comparées à celles de patient(e)s américain(ne)s qui se sont inscrits à la base de données du North American Research Committee on Multiple Sclerosis (NARCOMS).

Méthode:

Six cent soixante-cinq questionnaires auto-administrés sur les pratiques en matière de reproduction ont été envoyés aux patient(e)s éligibles inscrit(e)s à la CSPND. Un bref questionnaire a été complété et retourné aux auteurs de façon anonyme.

Résultats:

Quatre cent cinquante-neuf questionnaires complétés ont été retournés. La majorité desrépondant(e)s de la CSPND (72,5%) et un sous-groupe de la NARCOMS (dont 75,2% étaient des femmes), n'ont pas eu de grossesse après avoir reçu un diagnostic de SP. La raison en relation avec la SP la plus souvent évoquée pour justifier cette décision était « des symptômes qui interfèrent avec le rôle de parent » (75,0% pour la CSPND, 72,6% pour la NARCOMS). La raison la plus souvent évoquée, qui n'était pas reliée à la SP, était « la famille était complète » au moment du diagnostic dans les deux sous-groupes, la CSPND et la NARCOMS (58,0%et40,4%respectivement). Des préoccupations financières, tant reliées que non-reliées à la SP, étaient aussi fréquemment rapportées par les hommes et par les femmes des deux cohortes, mais significativement plus fréquemment par les participant(e)s de la NARCOMS.

Conclusion:

Ces résultats indiquent que les décisions des patient(e)s atteint(e)s de SP en matière de reproduction sont très influencées par leur maladie et l'invalidité qui y est associée, quel que soit le programme de soins de santé qui leur est disponible. Les professionnels de la santé devraient discuter avec les patient(e)s de leurs besoins et de leurs perceptions en matière de reproduction afin de les aider à prendre des décisions plus éclairées.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 4 , July 2013 , pp. 590 - 596
Copyright
Copyright © The Canadian Journal of Neurological 2013

References

1. Pugliatti, M, Sotgiu, S, Rosati, G. The worldwide prevalence of multiple sclerosis. Clin Neurol Neurosurg. 2002 Jul;104(3):182–91.CrossRefGoogle ScholarPubMed
2. Orton, SM, Herrera, BM, Yee, IM, et al. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol. 2006 Nov;5(11):932–6.CrossRefGoogle ScholarPubMed
3. McCarthy, M. The ‘gender gap’ in autoimmune disease. Lancet. 2000 Sep 23;356(9235):1088.CrossRefGoogle ScholarPubMed
4. Ramagopalan, SV, Sadovnick, AD. Genetics and epidemiology of multiple sclerosis. In: Giesser, BS, editor. Primer on multiple sclerosis. Oxford: Oxford University Press; 2011. p. 15.-29.Google Scholar
5. Poser, CM, Paty, DW, Scheinberg, L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983 Mar;13(3):227–31.Google Scholar
6. Katrych, O, Simone, TM, Azad, S, Mousa, SA. Disease-modifying agents in the treatment of multiple sclerosis: a review of long-term outcomes. CNS Neurol Disord Drug Targets. 2009 Dec;8(6):512–19.CrossRefGoogle ScholarPubMed
7. Vukusic, S, Hutchinson, M, Hours, M, et al. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain. 2004 Jun;127(Pt 6):1353–60.CrossRefGoogle ScholarPubMed
8. Devonshire, V, Duquette, P, Dwosh, E, Guimond, C. The immune system and hormones: review and relevance to pregnancy and contraception in women with MS. Int MS J. 2003 Jun;10(2):44–50.Google ScholarPubMed
9. Ramagopalan, S, Yee, I, Byrnes, J, Guimond, C, Ebers, G, Sadovnick, D. Term pregnancies and the clinical characteristics of multiple sclerosis: a population based study. J Neurol Neurosurg Psychiatry. 2012 Aug;83(8):793–5.Google Scholar
10. Verdru, P, Theys, P, D’Hooghe, MB, Carton, H. Pregnancy and multiple sclerosis: the influence on long term disability. Clin Neurol Neurosurg. 1994 Feb;96(1):38–41.Google Scholar
11. Koch, M, Uyttenboogaart, M, Heersema, D, Steen, C, De Keyser, J. Parity and secondary progression in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009 Jun;80(6):676–8.Google Scholar
12. Houtchens, MK. Pregnancy and multiple sclerosis. Semin Neurol. 2007 Nov;27(5):434–41.Google Scholar
13. Dahl, J, Myhr, KM, Daltveit, AK, Gilhus, NE. Pregnancy, delivery and birth outcome in different stages of maternal multiple sclerosis. J Neurol. 2008 May;255(5):623–7.CrossRefGoogle ScholarPubMed
14. Lu, E, Dahlgren, L, Sadovnick, A, Sayao, A, Synnes, A, Tremlett, H. Perinatal outcomes in women with multiple sclerosis exposed to disease-modifying drugs. Multiple Sclerosis. 2012 Apr;18(4):460–7.CrossRefGoogle ScholarPubMed
15. van der Kop, ML, Pearce, MS, Dahlgren, L, et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol. 2011 Jul;70(1):41–50.Google Scholar
16. Smeltzer, SC. Reproductive decision making in women with multiple sclerosis. J Neurosci Nurs. 2002 Jun;34(3):145–57.Google Scholar
17. Prunty, MC, Sharpe, L, Butow, P, Fulcher, G. The motherhood choice: themes arisin in the decision-making process for women with multiple sclerosis. Multiple Sclerosis. 2008;14:701–4.CrossRefGoogle Scholar
18. Alwan, S, Yee, IM, Dybalski, M, et al. Reproductive decision-making after the diagnosis of multiple sclerosis (MS). Mult Scler. 2012;19(3):351–8.Google Scholar
19. Consortium of Multiple Sclerosis Centers. NARCOMS Multiple Sclerosis Registry. (Accessed 14 February 2011 from www.mscare.org/cmsc/CMSC-NARCOMS-Information.html). Google Scholar
20. Marrie, RA, Cutter, G, Tyry, T, Campagnolo, D, Vollmer, T. Validation of the NARCOMS registry: diagnosis. Multiple Sclerosis. 2007 Jul;13(6):770–5.Google Scholar
21. Pomey, MP, Forest, PG, Palley, HA, Martin, E. Public/private partnerships for prescription drug coverage: policy formulation and outcomes in Quebec’s universal drug insurance program, with comparisons to the Medicare prescription drug program in the United States. Milbank Q. 2007 Sep;85(3):469–98.CrossRefGoogle Scholar
22. Canadian Network of MS Clinics. [cited 2011 Jun 3; Available from: http://www.cnmsc.org/ Google Scholar
23. Sadovnick, AD, Risch, NJ, Ebers, GC. Canadian collaborative project on genetic susceptibility to MS, phase 2: rationale and method. Canadian Collaborative Study Group. Can J Neurol Sci. 1998 Aug;25(3):216–21.Google Scholar
24. Ebers, GC, Sadovnick, AD, Risch, NJ. A genetic basis for familial aggregation in multiple sclerosis. Canadian Collaborative Study Group. Nature. 1995 Sep 14;377(6545):150–1.CrossRefGoogle ScholarPubMed
25. Sidak, Z. Rectangular confidence regions for the means of multivariate normal distributions. J Am Stat Assoc. 1967;62:626–33.Google Scholar
26. Payne, D, McPherson, KM. Becoming mothers. Multiple sclerosis and motherhood: a qualitative study. Disabil Rehabil. 2010;32(8):629–38.Google Scholar
27. Dwosh, E, Guimond, C, Duquette, P, Sadovnick, AD. The interaction of MS and pregnancy: a critical review. Int MS J. 2003 Jun;10(2):38–42.Google ScholarPubMed
28. Confavreux, C, Hutchinson, M, Hours, MM, Cortinovis-Tourniaire, P, Moreau, T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998 Jul 30;339(5):285–91.Google Scholar
29. Gulick, EE, Kim, S. Postpartum emotional distress in mothers with multiple sclerosis. J Obstet Gynecol Neonatal Nurs. 2004 Nov-Dec;33(6):729–38.CrossRefGoogle ScholarPubMed
30. Zorzon, M, Zivadinov, R, Bosco, A, et al. Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups. Multiple Sclerosis. 1999 Dec;5(6):418–27.Google ScholarPubMed
31. Stenager, E, Stenager, EN, Jensen, K. Sexual function in multiple sclerosis. A 5-year follow-up study. Ital J Neurol Sci. 1996 Feb;17(1):67–9.Google Scholar
32. Mattson, D, Petrie, M, Srivastava, DK, McDermott, M. Multiple sclerosis. Sexual dysfunction and its response to medications. Arch Neurol. 1995 Sep;52(9):862–8.Google Scholar
33. Callahan, ST, Cooper, WO. Access to health care for young adults with disabling chronic conditions. Arch Pediatr Adolesc Med. 2006 Feb;160(2):178–82.Google Scholar