Dr Mitzi Joi Williams Discusses Disparities in MS, Pregnancy in Minority Populations

Much more work needs to be done surrounding multiple sclerosis (MS) and treating pregnant patients safely, including more data collection surrounding pregnancy and MS, education for providers and patients, and studies on preventing disparate outcomes, noted Mitzi Joi Williams, MD, FAAN, medical director and CEO, Joi Life Wellness Neurology Clinic.

Williams is an author on several abstracts being presented at this year’s American Academy of Neurology Annual Meeting. In this interview, she discuss the findings of “Race Disparities in Pregnancy Care and Clinical Outcomes in Women With MS: A Diverse, Multicenter Cohort,” which was presented this afternoon.

Transcript

How do the etiology and pathophysiology of MS and pregnancy intersect such that the course of one can influence outcomes in the other?

We're learning a lot more about pregnancy and how to treat MS during pregnancy and how it behaves during pregnancy, really in the past couple of decades. There was really a previously hands-off approach to how we approach pregnancy; it was kind of that we stop medicine, we see what happens. And there weren't really studies looking at things like if the medicine passes into breast milk and how safe was it to do those things.

So the intersection is that, oftentimes, particularly if women became pregnant and had aggressive disease, they were not treated traditionally or even told not to have children. And then particularly in the breastfeeding period, when women are not treated, there often could be relapse of disease, or worse, severe consequences. So I think that that intersection has really become much more apparent, and there's an increasing need and understanding that we should be treating many of our patients during pregnancy and in the immediate postpartum period safely.

How do social determinants contribute to disparate outcomes in this medically complex population?

So, this is a very complex question. When we think about social determinants of health and how they affect outcomes, certainly access to care is an issue, but also experiencing discrimination within the health care system, particularly with our pregnant women. There have been multiple studies suggesting that mortality is much higher in Black and African American populations here in the US. And oftentimes, people's symptoms are not believed, which can lead to more severe outcomes. This is an issue that definitely needs to be addressed, but we see it in our MS patients who have an additional disability and chronic disease on top of that, and that can lead to even worse outcomes—because if their MS is not treated appropriately, they can have poor outcomes and not be able to take care of the children that they worked so hard to have.

What should be priorities in the study of health care inequity among Black and Hispanic vs White woman for neurological/obstetrical care?

There's a lot of work that needs to be done. We definitely need more data collection surrounding pregnancy and MS and treating people safely, and that information needs to be disseminated to the broader community. Because again, MS specialists, such as myself, represent a small percentage of those who are taking care of MS patients in the broader community. And so we definitely need education amongst our colleagues. We need patient education. And then we need studies to help us to understand how to safely treat our patients and how to make sure that we prevent disparate outcomes.

Then I think the other piece is also empowering our patients, that if they're not getting the care that they need, to be able to seek other opinions and make sure that they are being treated appropriately and collaborating with their neurologists to get the care they need.