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Reproductive Issues in Women With Multiple Sclerosis: Ethical Considerations

Morgan-Followell, Bethanie N. MD; Nicholas, Jacqueline A. MD, MPH; Weisleder, Pedro MD, PhD

doi: 10.1212/01.CON.0000443845.63804.9e
Ethical Perspectives

ABSTRACT: Addressing the reproductive concerns of women with multiple sclerosis (MS) is vital for comprehensive care. Contraception, conception, pregnancy, and breast-feeding present many vexing questions to the woman with MS. The risks and benefits of using disease-modifying therapy during the various stages of a woman’s reproductive life are topics that need to be discussed. The physician’s primary duty is to the patient; however, the physician must also consider the fetus and later the child. In helping guide the patient in making medical decisions, the physician must take into account the patient’s motivation for those decisions, including family obligations, cultural norms, and patient values. The physician is instrumental in providing the patient with sound, nonjudgmental information and advice so that she may make a well-informed, autonomous decision about her health and her disease.

Address correspondence to Dr Bethanie Morgan-Followell, 700 Children’s Drive, Columbus, OH 43205, Bethanie.morgan@nationwidechildrens.org.

Relationship Disclosure: Dr Morgan-Followell reports no disclosure. Dr Nicholas’ fellowship is funded through a Sylvia Lawry Physician Fellowship grant from the National Multiple Sclerosis Society, and she receives additional funding for clinical research from the National Multiple Sclerosis Society as an assistant professor. Dr Weisleder serves as a consultant for the Medical Review Institute of America and as associate editor of the Journal of Child Neurology.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Morgan-Followell, Nicholas, and Weisleder discuss the unlabeled use of disease-modifying therapies during attempts at conception and during pregnancy.

© 2014 American Academy of Neurology
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