Studio analitico dei pareri delle donne con sclerosi multipla e dei sanitari in merito all’utilizzo dell’opuscolo "The motherhood choice"

Background and aim: Motherhood in women with multiple sclerosis (SM) is an issue that concerns a large number of health professionals and resources of economic and social nature. Up to 1998, which is when the PRISM Study was published, professionals would advise women with SM against motherhood due to symptoSM and evolution of the neurodegenerative and demyelinating disease. PRISM study showed that the protective effect of pregnancy on the disease and neurologists began changing their attitude and the dosages in therapies, starting to discuss about how to treat the disease during pregnancy and postpartum. In 2007, Italian SM researchers coordinated by the Neuroepidemiology Institute C. Besta (Milan) linguistically validated an Australian Decision Aid titled The Motherhood choice. Since 2012, the Neuroepidemiology Institute C. Besta, in coollaboration with four Italian SM centers is leading a research funded by the Italian SM Foundation (Protocol No. 2010/S/2) about the effectiveness of the Decidere la maternità brochure, a Decision Aid about motherhood for women with SM. The assessment takes place through two questionnaires: the Women’s questionnaire, dedicated to women with SM, and the Health Personnel’s questionnaire, dedicated to professionals working with women with SM. The aim of this analytical study was to examine the opinions of women and health care professionals in order to identify the strenghts and weaknesses of the Decidere la maternità brochure, from a Midwife’s point of view for further upgrade. Materials and methods: An analytical study of the collected questionnaires (N=93) took place from October 2016 to January 2017. The sample consisted of 49 women with SM and 44 health care professionals coming from the four Italian SM centers involved in the research: Foundation IRCCS Neurological Institute C.Besta – Milan; IRCCS San Raffaele – Milan; University of Chieti and Pescara – Chieti; University of Bari. Descriptive statistics techniques were used to provide a description of the sample and come up with an analysis of the data that emerged from the answers given to the questionnaires by the two groups. Lastly, a summary of the comments of the participants about each question of the questionnaire was carried out, in order to identify the strenghts and weaknesses of the brochure. Results: 93/95% of the participants would recommend the Motherhood Choice decision aid and 100% of the health care professionals believes that the issue of motherhood is a common concern for these women. The difference between the two groups answering question no. 6 of the two questionnaires, the one concerning the ease of the 'options to consider' part, was statistically significant ( P Value = 0,0116). 4 strenghts and 5 weaknesses of the Decidere la Maternità brochure were identified and the suggestions made by the two groups to improve it were reported. Conclusions: Maternal desire is a subject on which women with SM often reflect; they need advice about it and support. The Decidere la maternità brochure is an effective tool for women with SM and health care professionals. To improve the outcomes of the Decision Aid and provide better and more appropriate maternity care, it is assumed that the pregnant woman with SM should be assisted by an equipe of professionals, for a pregnancy in which the woman is at the center and the midwife is by her side.