Pregnancy and Motherhood Concerns Surrounding Women with Multiple Sclerosis: A Qualitative Content Analysis

Document Type : Original Article

Authors

1 Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran;

2 Ministery of Health and Medical Education, Tehran, Iran

3 Department of Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran;

4 Department of Psychology, Shahed University, Tehran, Iran;

5 Department of Brain and Cognitive Sciences, Royan Institute for Stem Cell Biology and Technology, Royan Institute, Tehran, Iran

Abstract

Background: There is a high prevalence of multiple sclerosis (MS) among Iranian women of reproductive age. However, very few studies have been conducted in Iran to assess the experiences with and concerns about pregnancy and motherhood of such patients. The present study was conducted to better understand the experiences and concerns of women with MS about pregnancy and motherhood.
Methods: The present qualitative study was conducted from August 2016 to January 2017 among Iranian women with MS visiting the Iran MS Society in Tehran, Iran. The purposive sampling method was used to recruit the participants and the sampling was continued until data saturation. Based on the inclusion criteria, a total of 25 women with MS were recruited in the study. The data were collected by in-depth semi-structured face-to-face interviews and analyzed using the MAXQDA 10 software.
Results: The analysis of the interview data resulted in four main categories, namely “Pregnancy concerns”, “Fear of failing as a parent”, “Feeling of threatened fertility”, and “Lack of social support”. The results showed that Iranian women with MS avoided pregnancy due to the negative effects of the disease on their physical abilities and on life in general. They were also concerned about possible infertility, the effect of MS medications on their menstrual cycle, and the limitations of infertility treatments due to the presence of MS. These concerns led them to postpone pregnancy and lose time or opt for voluntary childlessness and consequently miss out on the experience of motherhood.
Conclusion: MS poses a serious challenge to women who consider getting pregnant and wish to experience motherhood. Health care professionals should support such patients to overcome their concerns and indecisiveness by providing appropriate information and counseling.

Keywords

References

  1. Kobelt G, Eriksson J, Phillips G, Berg J. The burden of multiple sclerosis 2015: Methods of data collection, assessment and analysis of costs, quality of life and symptoms. Multiple Sclerosis Journal. 2017;23:4-16.
  2. Lassmann H. Multiple sclerosis pathology. Cold Spring Harbor Perspectives in Medicine. 2018;8(3).
  3. Bartnik P, Wielgoś A, Kacperczyk-Bartnik J, et al. Evaluation of reproductive health in female patients with multiple sclerosis in Polish population. Journal of Clinical Neuroscience. 2018;53:117-21.
  4. Nabavi SM, Sangelaji B. Cognitive dysfunction in multiple sclerosis: Usually forgotten in the clinical assessment of MS patients. Journal of Research in Medical Sciences. 2015;20:533-4.
  5. Izadi S, Nikseresht A, Sharifian M, et al. Significant increase in the prevalence of multiple sclerosis in iran in 2011. Iranian Journal of Medical Sciences. 2014;39:152-3.
  6. Dehghan-Nayeri N, Khakbazan Z, Ghafoori F, Nabavi SM. Sexual dysfunction levels in iranian women suffering from multiple sclerosis. Multiple Sclerosis and Related Disorders. 2017;12:49-53.
  7. Payne D, McPherson KM. Becoming mothers: Multiple sclerosis and motherhood: a qualitative study. Disability and Rehabilitation. 2010;32:629-38.
  8. Lawler D, Begley C, Lalor J. (Re) constructing Myself: the process of transition to motherhood for women with a disability. Journal of Advanced Nursing. 2015;71:1672-83.
  9. Pozzilli C, Pugliatti M. An overview of pregnancy-related issues in patients with multiple sclerosis. European Journal of Neurology. 2015;22:34-9.
  10. Vukusic S, Marignier R. Multiple sclerosis and pregnancy in the’treatment era’. Nature Reviews Neurology. 2015;11:280-9.
  11. Prunty M, Sharpe L, Butow P, Fulcher G. The motherhood choice: themes arising in the decision-making process for women with multiple sclerosis. Multiple Sclerosis Journal. 2008;14:701-4.
  12. Smeltzer SC. Reproductive decision making in women with multiple sclerosis. Journal of Neuroscience Nursing. 2002;34:145-57.
  13. Pebdani RN, Johnson KL, Amtmann D, et al. Experiences and Perspectives of Pregnancy in Women with Multiple Sclerosis. Sexuality and Disability. 2015;33:47-52.
  14. Prunty MC, Sharpe L, Butow P, Fulcher G. The motherhood choice: a decision aid for women with multiple sclerosis. Patient Education and Counseling. 2008;71:108-15.
  15. Willson CL, Tetley J, Lloyd C, et al. The impact of multiple sclerosis on the identity of mothers in Italy. Disability and Rehabilitation. 2018;40:1456-67.
  16. Nasr Z, Majed M, Rostami A, et al. Prevalence of multiple sclerosis in Iranian emigrants: review of the evidence. Neurological Sciences. 2016;37:1759-63.
  17. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. 10th ed. Philadelphia: Wolters Kluwer Health; 2017.
  18. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24:105-12.
  19. Ulin PR, Robinson ET, Tolley EE. Qualitative methods in public health. CA(US): Jossey-Bass; 2005.
  20. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005;15:1277-88.
  21. Gentles SJ, Charles C, Ploeg J, McKibbon K. Sampling in qualitative research: Insights from an overview of the methods literature. The Qualitative Report. 2015;20:1772-89.
  22. Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Program Evaluation. 1986;30:73-84.
  23. Connelly LM. Trustworthiness in qualitative research. Medsurg Nursing. 2016;25:435-6.
  24. Kosmala-Anderson J, Wallace LM. A qualitative study of the childbearing experience of women living with multiple sclerosis. Disability and Rehabilitation. 2013;35:976-81.
  25. Smeltzer SC. The concerns of pregnant women with multiple sclerosis. Qualitative Health Research. 1994;4:480-502.
  26. Parton C, Katz T, Ussher JM. ‘Normal’and ‘failing’mothers: Women’s constructions of maternal subjectivity while living with multiple sclerosis. Health. 2019;23:516-32.
  27. Magyari M, Koch-Henriksen N, Pfleger CC, Sørensen PS. Gender and autoimmune comorbidity in multiple sclerosis. Multiple Sclerosis Journal. 2014;20:1244-51.
  28. Marrie RA, Reider N, Cohen J, et al. A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis. Multiple Sclerosis Journal. 2015;21:282-93.
  29. Nabavi SM, Koupai SA, Nejati MR, et al. Menstrual irregularities and related plasma hormone levels in multiple sclerosis patients treated with beta interferone. Acta Medica Iranica. 2010;48:36-41.
  30. Thöne J, Kollar S, Nousome D, et al. Serum anti-müllerian hormone levels in reproductive-age women with relapsing–remitting multiple sclerosis. Multiple Sclerosis Journal. 2015;21:41-7.
  31. McCombe PA, Stenager E. Female infertility and multiple sclerosis: Is this an issue? Multiple Sclerosis Journal. 2015;21:5-7.
  32. Sen A, Kushnir VA, Barad DH, Gleicher N. Endocrine autoimmune diseases and female infertility. Nature Reviews Endocrinology. 2014;10:37-50.
  33. Ferraro D, Simone AM, Adani G, et al. Definitive childlessness in women with multiple sclerosis: a multicenter study. Neurological Sciences. 2017;38:1453-9.
  34. Torkildsen Ø, Holmøy T, Myhr KM. Severe multiple sclerosis reactivation after gonadotropin treatment. Multiple Sclerosis and Related Disorders. 2018;22:38-40.
  35. Hellwig K, Brzosko B, Airas L, Smith EK. Fertility and Assisted Reproductive Techniques in Women with MS. Vienna: Springer; 2017.

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