Variance around MS and pregnancy: evolution of practice and areas of outstanding need

<h3>Introduction</h3> ABN UK Multiple sclerosis (MS) pregnancy guidelines provide a framework for counselling around disease modifying therapies (DMTs) in pregnancy and breastfeeding. However, evidence continues to evolve rapidly. We aimed to assess variation in practice around pregnancy, and compare this to previous findings from 2019. <h3>Methods</h3> An anonymous online survey assessing practice via direct questions and clinical scenarios was distributed via local networks and national mailing lists in June 2023. <h3>Results</h3> 110 responses were received from across the UK. Clinicians are now more likely to advise continuing DMTs at least until conception, compared to 2019. 90% advise continuing natalizumab during pregnancy compared to 65% in 2019. 79% advise continuing on natalizumab whilst breastfeeding, compared to 56% in 2019. Considerable variation exists in anti-CD20 DMTs prescription in pregnancy and breastfeeding. 46% consider continuing ofatumumab until conception, then stop it for the duration of the pregnancy, with substantial variation amongst the remainder. Guidelines were reported as the main drivers of change in practice. 37% were confident in advising someone with MS about IVF, with considerable variation in advice around IVF and DMT. Only 10% reported access to a dedicated obstetric MS clinic. <h3>Conclusion</h3> Guidelines drive change in practice, but need to be updated regularly. Areas of ongoing need include knowledge dissemination around IVF and assisted reproduction and investment in dedicated MS obstetric clinics.