Background: Demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica (NMO), and myelin oligodendrocyte glycoprotein antibody disorder (MOGAD) are prevalent in women of childbearing age. While practice guidelines are emerging for peripartum counseling in MS patients, the field still lacks data-driven recommendations for other demyelinating conditions.

Methods: To better understand the complications surrounding peripartum counseling in these disorders, we discuss three patients seen at the Brigham and Women’s Multiple Sclerosis Center with diagnoses of MS, NMO, and MOGAD, respectively. We review the literature, available guidelines, and ethical considerations for patients with demyelinating disease who are family planning.

Results: Although some aspects of peripartum counseling can be consistently applied across these conditions, in NMO and MOGAD the differences in peri-partum disease activity and the overall lack of data pose a greater challenge to patients and providers. Illness severity, maternal age, and exposure to disease modifying immunotherapies (DMTs) are all important and varied considerations.

Conclusions: Pregnancy planning in the context of DMTs and disease stability in patients with demyelinating disorders should be determined by both patient and provider. When data is limited, physicians may need to play a larger role in family planning discussions to guide toward the safest decision.