Family planning and multiple sclerosis - Part 1: Patient perspectives on treatment choices in Sweden.

BACKGROUND AND

OBJECTIVES

Family planning and treatment management in women with multiple sclerosis (MS) require complex decision-making. In most cases, patients express their intention to start a family, giving physicians time to monitor their MS and align treatment plans accordingly. However, not all pregnancies are planned, which can make timely communication with healthcare providers challenging. This study explores the dynamics between patients and healthcare professionals in MS care, focusing on family planning and treatment decisions before, during, and after pregnancy.

METHODS

People with MS aged 20-50 in the Swedish MS register (SMSreg) were invited to participate in an online survey in 2021. Responses of 3078 women were linked to SMSreg and other national register datasets. Descriptive statistics and multinomial logistic regression explored information sources, care, family planning discussion, treatment satisfaction, and its impact on their disease and breastfeeding decisions.

RESULTS

Women with MS reported receiving annual care from a neurologist (88%), nurse (68%) or general practitioner (46%), with satisfaction ranging from 40-77%. Most were treated with high efficacy (HE) disease-modifying treatments (DMTs) (66%), of whom 49% used rituximab. Treatment satisfaction was higher among younger women, milder EDSS, and those on HE DMTs. Women who became pregnant after their MS diagnosis (41%) were more likely to have discussed family planning with a physician (78%) compared to those who had not been pregnant post-diagnosis (59%).

DISCUSSION: In Sweden, women with MS generally have regular contact with healthcare professionals, though satisfaction varies. Family planning discussions were more frequent among women who became pregnant after diagnosis, highlighting the importance of proactive communication. Treatment choices influence both satisfaction and reproductive decisions, underscoring the need for clear guidance and shared decision-making. Real-world data also indicate that rituximab is commonly used during peripregnancy, likely due to its favourable safety profile and long-lasting effect.