What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature

Background Although several papers report on pregnancy and multiple sclerosis (MS), no systematic review of the literature has been carried out. Neurologists and obstetricians need to have proper information to discuss with women presenting with MS who consider pregnancy. Objectives Literature review and meta-analysis of data on pregnancy in women with MS. Search strategy The present work followed the recommendations of the PRISMA Statement. Using the PICO framework, the authors independently searched for the terms 'pregnancy' OR 'gestation' OR 'pregnant' AND 'multiple sclerosis' OR 'MS' in the following databases: EMBASE/Excerpta Medica, Medline, Pubmed, Scopus, Index Medicus, Biomed Central, Ebsco Fulltext, LILACS, Scielo and the Cochrane Database of Systematic Reviews. Selection criteria: only papers presenting original work with analysis of at least one of the outcomes among pregnant women with MS were included. Data collection and analysis Two independent workers performed the literature review. All the authors selected and read the relevant papers. Two other authors summarised data for analysis. Main results Twenty-two papers reporting on 13 144 women with MS and their pregnancies were analysed. A significant decrease in relapse rate was observed during pregnancy, followed by a significant increase after delivery. Miscarriages, low birthweight, prematurity, neonatal death and malformations were assessed among these women and their offspring. There seems to be a regional influence on the rates of caesarean sections and abortions among women with MS. Neonatal death and malformation rates did not seem to be particularly high. Authors' conclusions The present work provides evidence-based data that can be discussed with women with MS and their relatives when pregnancy is considered by these families.