A systematic review of consensus recommendations and guidelines on the management and care of women with multiple sclerosis through pre-pregnancy, pregnancy, and postpartum periods

Expectant mothers with multiple sclerosis (MS) face several challenges during pregnancy and after giving birth. The purpose of this research was to conduct a systematic review aimed at providing a comprehensive set of clinical recommendations for managing and caring for women with MS during pregnancy and the postpartum period. The databases of ISI, PubMed, Scopus, and websites of organizations related to Multiple Sclerosis were searched using the keywords Multiple Sclerosis,” “Disseminated Sclerosis,” “Labor,” “Childbirth,“,” child-birth”, “Pregnancy,” “Postpartum,” “Breastfeeding,” " Breast-feeding “,“Delivery,” “Pre-pregnancy,” “Pre pregnancy”, “Family planning,” “Guideline,” “Consensus Statement*”, “Code* of Practice,” and “Practical Guidance, without time limit up to September 2025. All guidelines, best practices, and consensus recommendations regarding MS and pregnancy and postpartum were included in the study. The included documents were reviewed and extracted data were qualitatively synthesized. Analysis of 10 documents revealed seven consensus recommendations, one formal expert consensus, one practical recommendation and one guideline. Two of these documents focused specifically on France and two on the United Kingdom, while the remaining six originated from Saudi Arabia, Argentina, the United States, Italy, Switzerland and Australia and New Zealand. The information obtained from the reviewed documents was categorized into six main categories: Pre-pregnancy Considerations, Pregnancy Considerations, Delivery, Postpartum Considerations, Symptomatic Treatments, and Magnetic resonance imaging (MRI) and Monitoring. This study identifies significant gaps in the care of women with MS from pre-pregnancy to the postpartum period. Despite a consensus on the importance of multidisciplinary, patient-centered care, particularly in patient participation, comprehensive care coverage, and coordinated recommendations for Disease-Modifying Therapies management, these gaps persist. Future guidelines should incorporate active patient involvement, real-world evidence, and psychosocial and educational supports, in addition to clinical interventions, to enhance the quality and safety of care. PROSPERO registration number: CRD420251248093.