- There are very limited resources for Australian healthcare professionals to help guide people with MS in family planning decisions.
- Researchers interviewed Australian neurologists and MS Nurses about how they approach family planning considerations for people with MS.
- A range of approaches were used, and many specialists identified the need for better local information resources.
Multiple sclerosis (MS) usually presents during a person’s reproductive years.
For those planning a family, a key goal is to stabilise MS disease activity prior to conception, most often using disease-modifying therapies (DMTs).
In recent years, there has also been a general move towards using more effective DMTs earlier in MS.
However, some DMTs are known to, or could potentially cause, harm to the unborn baby.
Therefore, it is so important for people taking these medications to be aware of the potential risks and use reliable forms of contraception. MS specialists play a key role in supporting family planning.
A recent study led by Anna Fragkoudi from the University of Adelaide found that people with MS expressed a desire for more frequent and comprehensive discussions with their MS specialist around reproduction.
However, it is unclear how issues of family planning are addressed in the clinical setting by MS specialists.
What was the aim of this work?
In a new follow-up study published in Multiple Sclerosis and Related Disorders, the researchers sought to understand how MS specialists manage family planning in people with MS in Australia.
What did the researchers do?
The researchers conducted one-on-one semi-structured interviews with nine neurologists and ten MS nurses across Australia who regularly provide care to people with MS of reproductive age.
The specialists were asked about their current approaches to managing family planning, availability of family planning resources, and opportunities for improvement.
What did the researchers find?
Two main themes emerged.
First, there were ‘inconsistent approaches in providing family planning’ among the MS specialists.
- Neurologists and MS nurses recognised the importance of offering family planning guidance, but there were variations in the content, timing, and extent of FP discussions.
- There were conflicts between reproductive considerations and DMT prescriptions according to risk to the fetus.
- Neurologists highlighted the need to consider multiple factors, such as the severity and activity of MS, when prescribing DMTs, especially in the context of family planning.
- Half of the participating neurologists reported they are more likely to prescribe a safer DMT if the person with MS is a woman of reproductive age.
- For men planning a family, some neurologists mentioned limited options for DMTs, as certain medications were found to be toxic to sperm.
- There was also variability in the implementation of family planning approaches across different specialties, including referrals by neurologists to MS Nurses, GPs, obstetricians, and fertility specialists.
Second, the MS specialists experienced ‘barriers in providing family planning’. These included:
- a lack of local information resources on family planning
- Insufficient pregnancy and fertility safety data for certain DMTs and
- Various patient and professional factors, such as time constraints, influence the ability to provide comprehensive family planning guidance.
What does this mean for the MS community?
MS clinical specialists consider family planning as an essential part of the care of their patients.
Currently, there are very limited Australian resources, such as guidelines or recommendations, specifically addressing MS and family planning. This gap poses a challenge for MS specialists in guiding discussions related to family planning.
The majority of specialists discussed the importance of having a dedicated information resource specifically tailored to the Australian context to guide conversations and ensure consistency in family planning and reproductive care for people with MS.
They identified the need for simple printed materials in plain English, that are culturally appropriate.
Many specialists suggested using networks, such as those provided by MS organisations, to raise awareness and disseminate family planning information.
Research lead Anna Fragkoudi said, “We hope this study will inform new strategies to support decision-making around disease management and family planning for Australians who live with MS. We further hope to work with Australian MS organisations towards the development of resources for this purpose.”
