Pregnancy in Multiple Sclerosis: A Questionnaire Study

<div><p>Background</p><p>Multiple sclerosis (MS) preferentially affects females at childbearing age. For this reason patients and treating physicians were frequently confronted with questions concerning family planning, pregnancy and birth.</p><p>Objective</p><p>The aim of this study was to evaluate the expertise about pregnancy related topics in multiple sclerosis of neurologists in private practice.</p><p>Methods</p><p>We developed a survey with 16 multiple choice questions about pregnancy related topics and sent it to neurologists in private practice in Berlin, Germany.</p><p>Results</p><p>56 completed questionnaires were sent back. 54% of all questions were answered correctly, 21% of the questions were answered with “I don’t know”. Correct answers were more often given by physicians who treat more than 400 MS patients per year (p = 0.001). Further positive associations were found for assumed relevance of the topic (p = 0.002) and the degree of counseling (p<0.001).</p><p>Conclusion</p><p>To provide a comprehensive counseling, MS patients with desire for children should be counseled by physicians with a lot of experience in MS treatment.</p></div

Survey results.

<p>IMT: immunomodulatory therapy.</p

Percentage of correct and I don’t know-answers in relation to the number of treated MS patients per quarter: Kruskal-Wallis-test.

<p>Percentage of correct and I don’t know-answers in relation to the number of treated MS patients per quarter: Kruskal-Wallis-test.</p

Demographic characteristics.

<p>Demographic characteristics.</p

Sample OCT measurement and segmentation.

<p>A) Sample scanning laser ophthalmoscopy image showing the peripapillary ring-scan for retinal nerve fiber layer analysis. Nasal and temporal quadrants were analyzed separately B) Sample scanning laser ophthalmoscopy image showing the B-scans included in the segmentation procedure (green and blue) and the area included into analysis (blue only). C) Sample macular scan showing the segmentation lines and intra-retinal layer layout. Red segmentation lines provided by the software define the macular retinal nerve fiber layer (mRNFL), the ganglion cell layer (GCL), the inner plexiform layer (IPL), the inner nuclear layer (INL), the outer plexiform layer (OPL), the outer nuclear layer (ONL), and inner segments of the photoreceptor layer (IS). OPL, ONL and IS were analyzed combined as outer retinal layers (ORL). D) Sample B-scan of an NMOSD patient with microcystic macular edema (MME).</p

Sample patient data from NMOSD and MS eyes.

<p>A) Peripapillary retinal nerve fiber layer (pRNFL) thickness data (in µm) for average RNFL (G) and sectors (nasal-superior quadrant (NS), temporal-superior (TS), temporal, temporal-inferior (TI), nasal-inferior (NI) and nasal (N)) for a multiple sclerosis (MS) patient’s eye with a previous optic neuritis (ON) (left), a neuromyelitis optica spectrum disorder (NMOSD) patient’s eye with a previous ON without microcystic macular edema (MME) (center), and an NMOSD patient’s eye with previous ON and MME (right). Background colors describe the comparison to a healthy reference group from the device’s database. B) and C) Thickness maps of the retinal ganglion cell layer (GCL, B) and inner nuclear layer (INL, C) respective to the patients’ data from A).</p

Intra-retinal layer thickness in NMOSD-ON eyes with and without microcystic macular edema.

<p>Layer thicknesses for the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL) and the combined outer retinal layers for NMOSD-ON eyes with (MME+, in red) and without (MME-, in blue) microcystic macular edema and healthy controls eyes (HC, in green). Outer retinal layers include outer plexiform layer, outer nuclear layer and inner photoreceptor layer segments.</p

Retinal morphology in eyes without previous ON.

<p>Results of retinal OCT outcomes of NMOSD and MS patients’ eyes without history of optic neuritis and healthy controls; GEE results showing the differences between NMOSD-NON and MS-NON to healthy controls. Outer retinal layers include outer plexiform layer, outer nuclear layer and inner photoreceptor layer segments.</p><p><b>Abbreviations:</b> NMOSD: neuromyelitis optica spectrum disorder; MS: multiple sclerosis; NON: eyes without history of optic neuritis; HC: healthy controls; OCT: optical coherence tomography; p/mRNFL: peripapillary and macular retinal nerve fiber layer; TMV: total macular volume; GCL: ganglion cell layer; IPL: inner plexiform layer; INL: inner nuclear layer; SD: standard deviation; Min: minimum; Max: maximum; B: coefficient estimate from generalized estimating equation models (GEE), SE: standard error from GEE coefficient estimates.</p

Retinal morphology in eyes after ON.

<p>Results of retinal OCT outcomes of NMOSD and MS patients’ eyes after optic neuritis and healthy controls; GEE results showing the differences between NMOSD-ON and MS-ON and NMOSD-ON to healthy controls.</p><p><b>Abbreviations:</b> NMOSD: neuromyelitis optica spectrum disorder; MS: multiple sclerosis; NON: eyes without history of optic neuritis; HC: healthy controls; OCT: optical coherence tomography; p/mRNFL: peripapillary and macular retinal nerve fiber layer; TMV: total macular volume; GCL: ganglion cell layer; IPL: inner plexiform layer; INL: inner nuclear layer; SD: standard deviation; Min: minimum; Max: maximum; B: coefficient estimate from generalized estimating equation models (GEE), SE: standard error from GEE coefficient estimates.</p

Demographic and clinical overview.

<p><b>Abbreviations:</b> NMOSD: neuromyelitis optica spectrum disorders; RRMS: relapsing-remitting multiple sclerosis; HC: healthy controls; AQP4-Ig: aquaporin 4 antibodies; ON: optic neuritis, n/a = not applicable (the resp. data did not apply to this group).</p