医学
母乳喂养
怀孕
多发性硬化
德尔菲法
家庭医学
危害
梅德林
循证实践
重症监护医学
替代医学
儿科
精神科
心理学
社会心理学
统计
遗传学
政治学
法学
生物
数学
病理
作者
Priyanka Iyer,Kate Wiles,Azza Ismail,Surabhi Nanda,Katy Murray,Stella Hughes,Helen Ford,Owen Pearson,Sarah J. White,Nicola Bonham,Natasha Hoyle,James Witts,Rod Middleton,Peter Brex,David Rog,Ruth Dobson
标识
DOI:10.1177/13524585221148094
摘要
Multiple sclerosis (MS) is frequently diagnosed in people of reproductive age, many of whom will become pregnant following diagnosis. Although many women report an improvement in symptoms and relapses during pregnancy, symptoms such as fatigue and spasticity are commonly reported and can worsen. Prescribing medications during pregnancy and breastfeeding presents unique challenges and guidance on the use of symptomatic therapies is limited.This paper aims to provide a consensus on the current evidence base to facilitate informed decision-making and optimise pre-conception counselling.A list of most commonly prescribed medications for symptom management in MS was created using pregnancy and MS-related READ codes in the Welsh GP Dataset, followed by a review by MS neurologists.A final list of 24 medications was generated for review. Searches were performed on each medication, and evidence graded using standardised criteria. Evidence-based recommendations were developed and distributed to experts in the field and revised according to feedback using modified Delphi criteria.Our guidelines provide evidence-based recommendations on the safety of symptomatic therapies during pregnancy and breastfeeding for general practitioners and specialist teams working with people with MS who are hoping to embark on pregnancy or are currently pregnant. Individual risk-benefit ratios should be considered during pre-conception counselling to optimise symptom burden and minimise harm to both parent and child.
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