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

Sandra Vukusic (1, 2, 3, 4) , Clarisse Carra-Dalliere (5) , Jonathan Ciron (6, 7, 8) , Elisabeth Maillart (9, 10) , Laure Michel (11, 12) , Emmanuelle Leray (13, 14, 15) , Anne-Marie Guennoc (16) , Bertrand Bourre (17) , David Laplaud (18) , Géraldine Androdias (19) , Caroline Bensa (20) , Kevin Bigaut (21, 22) , Damien Biotti (6, 7, 8) , Pierre Branger (23) , Olivier Casez (24, 25, 26) , Mikael Cohen (27) , Elodie Daval (28) , Romain Deschamps (10, 29) , Cécile Donze (30, 31, 32) , Anne-Laure Dubessy (33) , Cécile Dulau (34) , Françoise Durand-Dubief (35) , Maxime Guillaume (36) , Benjamin Hebant (36) , Laurent Kremer (21) , Arnaud Kwiatkowski (37) , Julien Lannoy (38) , Adil Maarouf (39) , Eric Manchon (40) , Guillaume Mathey (41) , Xavier Moisset (42) , Alexis Montcuquet (34) , Julie Pique (1, 35) , Thomas Roux (10) , Romain Marignier (1, 35) , Christine Lebrun-Frenay (28, 43)

1 CRNL - Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
2 OFSEP - Observatoire Français de la Sclérose En Plaques [Lyon]
3 UCBL - Université Claude Bernard Lyon 1
4 Fondation Eugène Devic EDMUS
5 Hôpital Gui de Chauliac
6 Infinity - Institut Toulousain des Maladies Infectieuses et Inflammatoires
7 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
8 CRC-SEP - Centre Ressources et Compétences sclérose en plaques (CRC-SEP) [CHU Toulouse]
9 CHU Pitié-Salpêtrière [AP-HP]
10 CRC-SEP Paris APHP - Centre de Ressources et de Compétences sur la Sclérose en Plaques (CRC-SEP) [CHU Pitié-Salpêtrière]
11 CIC - Centre d'Investigation Clinique [Rennes]
12 CHU Pontchaillou [Rennes]
13 EHESP - École des Hautes Études en Santé Publique [EHESP]
14 ARENES - Centre de Recherches sur l'Action Politique en Europe
15 RSMS - Recherche sur les services et le management en santé
16 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
17 Service de neurologie [Rouen]
18 CIC Nantes - Centre d’Investigation Clinique de Nantes
19 HCL - Hospices Civils de Lyon, Departement de Neurologie
20 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
21 CRC-SEP Alsace - Centre de Ressources et de Compétences sur la Sclérose en Plaques (CRC-SEP) [Strasbourg]
22 Les Hôpitaux Universitaires de Strasbourg (HUS)
23 Service de Neurologie [CHU Caen]
24 UGA - Université Grenoble Alpes
25 TIMC-T-RAIG - Translational Research in Autoimmunity and Inflammation Group
26 TIMC-IMAG - Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications Grenoble - UMR 5525
27 CRC-SEP Côte d'Azur - Centre Ressources et Compétences sclérose en plaques (CRC-SEP) [CHU de Nice Pasteur 2]
28 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
29 Fondation Ophtalmologique Adolphe de Rothschild [Paris]
30 GHICL - Groupe Hospitalier de l'Institut Catholique de Lille
31 Hôpital Saint Philibert [Lomme]
32 F2M2S - Faculté de Médecine, Maïeutique, Sciences de la Santé - Campus VAUBAN [Lille]
33 CHU Saint-Antoine [AP-HP]
34 CRC-SEP - Hôpital Pellegrin - Centre Ressources et Compétences sclérose en plaques (CRC-SEP) [CHU de Bordeaux]
35 Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
36 CHU Rouen
37 UCL - Université catholique de Lille
38 Centre Hospitalier de Lens
39 CRMBM - Centre de résonance magnétique biologique et médicale
40 Centre Hospitalier de Gonesse
41 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
42 Neuro-Dol - Neuro-Dol
43 URRIS UR2CA - Unité de Recherche Clinique de la Côte d’Azur [Nice]

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.

Keywords: Multiple sclerosis; breastfeeding; disease-modifying treatments; pregnancy; reproductive assistance

Domains: Life Sciences [q-bio]

Sandra Vukusic, Clarisse Carra-Dalliere, Jonathan Ciron, Elisabeth Maillart, Laure Michel, et al.. Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society. Multiple Sclerosis Journal, 2023, 29 (1), pp.11-36. ⟨10.1177/13524585221129472⟩. ⟨hal-03882738⟩