How misinformation affects family planning choices for women with multiple sclerosis

Multiple sclerosis (MS) predominantly affects women of childbearing age. Despite growing evidence supporting the safety of pregnancy in women with MS, the disease continues to influence reproductive choices due to concerns about maternal and infant outcomes, treatment safety, and disease prognosis.

To assess fertility preferences, MS-related knowledge, perceived risks, and sources of information among women with MS of reproductive age.

This cross-sectional study included women aged 18-45 years from the prospective Barcelona First-Attack Cohort. Participants completed a 62-item self-administered survey addressing sociodemographic factors, fertility preferences, disease-related concerns, knowledge regarding MS and pregnancy, and sources of reproductive information. Descriptive and bivariate analyses were performed.

Between May and July 2023, 282 out of 409 MS women aged 18-45 years were contacted, and 200 consented to participate. Of these, 34% expressed a desire for children, 16% were undecided, and 50% did not wish to have children. MS influenced reproductive decisions in 59% of participants, particularly through changes in pregnancy timing and desired number of children. Key concerns included disease exacerbation postpartum (36.5%), the risk of MS development in offspring (24.5%), and fetal harm from disease-modifying therapies (DMTs) (23.5%). Significant misinformation was observed, especially regarding the safety of DMTs during breastfeeding, postpartum relapse risk, and epidural anesthesia. Only 24% of participants had received recent counseling on MS and pregnancy, predominantly initiated by the patient.

Despite robust evidence supporting the safety of pregnancy in MS, misconceptions persist and influence reproductive choices. Proactive, individualized counseling-particularly by MS-specialized professionals-should be integrated into routine care to support informed reproductive decision-making.