Abortion Bans Are Likely to Restrict Care for MS Patients: Researchers

Reproductive restrictions may lead neurologists to avoid therapies that might cause toxicity during pregnancy, researchers say

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by Marisa Wexler, MS |

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Note: This story was updated on July 25, 2022, for the headline to reflect researchers gave this information in a perspective paper, not a study. 

Bans on abortion and other reproductive care limitations are likely to have a profound impact on the care of people with multiple sclerosis (MS) and other neurological conditions following the U.S. Supreme Court’s overturning of Roe v. Wade, according to a new perspective paper.

“Bans on abortion will immediately affect the delivery of current standard neurologic care for many patients, specifically standards that depend on planning or preventing pregnancies using individual choice,” its authors wrote.

The viewpoint paper, “Reproductive Rights in Neurology—The Supreme Court’s Impact on All of Us,” was published in JAMA Neurology.

The U.S. Supreme Court ruled on Dobbs v. Jackson Women’s Health Organization in June, overturning five decades of precedent that the right to an abortion to terminate a pregnancy was a constitutional guarantee.

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Scientists at the University of California, San Francisco outlined how this policy shift is likely to impact the field of neurology.

In the wake the of the court’s decision, bans or severe restrictions on abortions are expected, or already enacted, in 28 states. These decisions are expected to restrict abortion access for more than half of women of reproductive potential in the U.S., the researchers said. They also noted that abortion access “is not exclusively a women’s rights issue—those who do not identify as women, such as transgender men and nonbinary people, may also seek abortion.”

The researchers noted that abortion care is more commonly sought by people who are below the federal poverty line, and that rates are higher among Black and Hispanic women compared with their white peers. Furthermore, studies have shown that people who want an abortion, but are unable to get one, are in the long run more likely to be unemployed and in poverty.

“Therefore, restrictions on reproductive rights may differentially affect the health of women according to their race, ethnicity, or income levels and could further entrench women in a cycle of poverty,” the researchers wrote.

These concerns are particularly relevant to the field of neurology because many neurological diseases — including MS — disproportionately affect women during their reproductive years.

“Availability of reproductive health is integral to equitable delivery of neurologic care,” the researchers wrote.

Many medications that manage neurological conditions are teratogenic, meaning they’re known to cause toxicity to a developing fetus if used during pregnancy. The researchers noted the approved MS therapy Aubagio (teriflunomide) as one example.

Usually, teratogenic medications are only prescribed when patients are able to avoid becoming pregnant while on the therapy.

“However, unintended pregnancies occur, even among participants in clinical trials with protocols that strictly encourage or require use of effective contraception, and these pregnancies will continue to occur regardless of legislative constraints on reproductive health services,” the researchers wrote, adding that precise timing of these medications may not be feasible in some medical scenarios.

The research team also noted for many medications that treat MS and other conditions, the safety profile during pregnancy is not known. Limitations on reproductive freedom may prompt neurologists to avoid therapies that might cause toxicity during pregnancy, even though those medications might be the optimal choice for those patients.

“In a climate of increased limitations on reproductive rights, whereby pregnancies cannot be reliably timed or prevented, neurologists might possibly restrict use of the effective medications that are standard care for other patient groups because of potential concerns about causing fetal harm. This could increase risk of morbidity, mortality, and irreversible disability accumulation for women with neurologic diseases,” they wrote.

“In many settings, women with MS are treated with less effective therapies, because these medications are perceived to be safer in pregnancy,” Riley Bove, MD, a co-author from UCSF’s department of neurology, said in a university press release. “The reversal of Roe v. Wade may reinforce decisions to stick with the less effective therapies, which may result in irreversible disability for some women with MS.”

Limiting reproductive care will have profound consequences in fetal neurology, the researchers said. They noted that, in worst-case scenarios, fetal neurologists may be diagnosing conditions that are inherently fatal or will profoundly limit a child’s quality of life.

“The decision to carry or terminate a pregnancy with severe fetal anomalies … or genetic syndromes … is highly complex and personal regardless of which decision each woman makes. If pregnancy termination is banned, then women may be forced against their wishes to deliver a newborn that may require prolonged intensive care and end-of-life care,” the research team wrote.

“The loss of bodily autonomy for pregnant women in such a scenario conscripts the dyad of mother and child to potential physical and psychological morbidity. Women and their partners will not have the right to self-determination, as well as the ability to make reasonable and informed decisions for the health and welfare of their child and family,” the researchers said.

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