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RESEARCH PAPER
The multifactorial nature of reproductive decision-making
among women with multiple sclerosis
1
Department of Midwifery,
Faculty of Health and Care
Sciences, University of West
Attica, Athens, Greece
2
Kauno Kolegija Higher
Education Institution, Kaunas,
Lithuania
3
Department of Psychology,
Greek Multiple Sclerosis Society,
Athens, Greece
4
Department of Neurology,
Greek Multiple Sclerosis Society,
Athens, Greece
5
Athens Naval Hospital, Athens,
Greece
Submission date: 2026-03-15
Final revision date: 2026-06-02
Acceptance date: 2026-06-09
Publication date: 2026-08-31
Corresponding author
Antigoni Sarantaki
Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Ag. Spyridonos Str., 12243, Athens, Greece
Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Ag. Spyridonos Str., 12243, Athens, Greece
Eur J Midwifery 2026;10(August):38
KEYWORDS
multiple sclerosisreproductive decision-makingpsychosocial adaptationchronic illness adjustmentequity
TOPICS
ABSTRACT
Introduction:
Multiple sclerosis (MS) is a chronic neurological disease that frequently affects women during their reproductive years and may influence fertility intentions and family planning decisions. This study aimed to identify factors associated with reproductive choices among women with MS and to examine the role of psychological, social, and disease-related variables in fertility decision-making.
Methods:
A cross-sectional study was conducted in Greece between August 2023 and December 2024, involving 103 women aged 18–50 years with neurologist-confirmed MS (mean age: 38.05 ± 7.01 years). Participants were recruited from the Naval Hospital of Athens and the Greek Multiple Sclerosis Society. Structured questionnaires assessed social support, psychological wellbeing, relationship dynamics, repro-ductive motivation, and quality of life. Associations between clinical, psychosocial, and demographic var-iables and childbearing were examined using univariate analyses and binary logistic regression.
Results:
In univariate analyses, childbearing was associated with relapsing–remitting MS compared with progressive disease forms (73.9% vs 0%, p=0.001), marital status (all unmarried women were childless, p=0.001), fingolimod exposure (all users were childless, p=0.008), higher mental health scores (p=0.035), greater health-related distress (p=0.006), and stronger fatalistic motivation for parenthood (p=0.005). However, in multivariable logistic regression, none of these variables independently predicted childbearing status (all p>0.05).
Conclusions:
These findings suggest that reproductive decision-making among women with MS may involve multiple disease-related, psychological, and relationship-related considerations. Further studies with larger sample sizes are needed to confirm these associations.
Multiple sclerosis (MS) is a chronic neurological disease that frequently affects women during their reproductive years and may influence fertility intentions and family planning decisions. This study aimed to identify factors associated with reproductive choices among women with MS and to examine the role of psychological, social, and disease-related variables in fertility decision-making.
Methods:
A cross-sectional study was conducted in Greece between August 2023 and December 2024, involving 103 women aged 18–50 years with neurologist-confirmed MS (mean age: 38.05 ± 7.01 years). Participants were recruited from the Naval Hospital of Athens and the Greek Multiple Sclerosis Society. Structured questionnaires assessed social support, psychological wellbeing, relationship dynamics, repro-ductive motivation, and quality of life. Associations between clinical, psychosocial, and demographic var-iables and childbearing were examined using univariate analyses and binary logistic regression.
Results:
In univariate analyses, childbearing was associated with relapsing–remitting MS compared with progressive disease forms (73.9% vs 0%, p=0.001), marital status (all unmarried women were childless, p=0.001), fingolimod exposure (all users were childless, p=0.008), higher mental health scores (p=0.035), greater health-related distress (p=0.006), and stronger fatalistic motivation for parenthood (p=0.005). However, in multivariable logistic regression, none of these variables independently predicted childbearing status (all p>0.05).
Conclusions:
These findings suggest that reproductive decision-making among women with MS may involve multiple disease-related, psychological, and relationship-related considerations. Further studies with larger sample sizes are needed to confirm these associations.
ABBREVIATIONS
MS: Multiple sclerosis, MARU: Medically Assisted Reproduction Unit, NHA: Gyne-cological and Neurology Clinics of the Naval Hospital of Athens, GMSS: Greek Multiple Sclerosis Society, OSSS: Oslo Social Support Scale, DAS: Dyadic Adjustment Scale, PM2: Motivation for Parenthood Ques-tionnaire, PS: Positivity Scale, MSQO: Multiple Sclerosis Quality of Life, BFI: Big Five Personality Inventory
ACKNOWLEDGEMENTS
This manuscript is available as a pre-print37 on Preprints.org
(https://doi.org/10.20944/preprints202510.1537.v1).
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form
for Disclosure of Potential Conflicts of Interest and none was
reported.
FUNDING
There was no source of funding for this research. Kauno Kolegija
Higher Education Institution covers the APCs of open access
publication.
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval was obtained from the Ethics Committee
Scientific Council of the University of West Attica (Approval
number: 66025; Date: 10 July 2023) in accordance with the
General Data Protection Regulation (GDPR). Participants provided
informed consent.
DATA AVAILABILITY
The data supporting this research are available from the authors
on reasonable request.
AUTHORS' CONTRIBUTIONS
PD and AS: manuscript draft. PD and AS: study concept and
design. PD, ST, VJ, KG, AS, NP, AO and AL: data acquisition and
analysis, PD, KG, AL, ST, AO, VJ and AS: intellectual content and
manuscript editing. All authors read and approved the final version of the manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
SUPPLEMENTARY FILE DISCLAIMER
The content has been provided by the author(s) and has not been reviewed, verified, or endorsed by European Publishing. It may not have undergone peer review. The views, opinions, and recommendations expressed are solely those of the author(s) and do not necessarily reflect the position of European Publishing. European Publishing accepts no responsibility or liability for any consequences arising from the use of, or reliance on, this content.
The content has been provided by the author(s) and has not been reviewed, verified, or endorsed by European Publishing. It may not have undergone peer review. The views, opinions, and recommendations expressed are solely those of the author(s) and do not necessarily reflect the position of European Publishing. European Publishing accepts no responsibility or liability for any consequences arising from the use of, or reliance on, this content.
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| eISSN: | 2585-2906 |
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