ME/CFS and pregnancy: a systematic review
When reviewing studies of pregnancy in women living with ME/CFS, researchers from Newcastle University found the impact of pregnancy on ME/CFS severity varied within and between the small number of relevant studies.
The importance of both individualised care, and of healthcare professionals learning about ME/CFS in relation to family planning and pregnancy was however highlighted.
There are currently no evidence-based guidelines for management of ME/CFS and pregnancy. People with ME/CFS, their partners and healthcare professionals are unable to make informed, evidence-based decisions around family planning, pregnancy, labour and birth.
“More research is urgently needed, considering all aspects of pregnancy and ME/CFS for patients and healthcare professionals. In particular, research should explore what would constitute high-quality care for those with ME/CFS relating to pregnancy and family planning.”
Better quality research is also needed, with larger sample sizes, healthy control groups, clearly defined research questions and a standard diagnostic criteria for ME/CFS.
Identifying, synthesising and appraising existing evidence relating to myalgic encephalomyelitis/chronic fatigue syndrome and pregnancy: a mixed-methods systematic review, by Emma Slack, Katrina Anne Pears, Judith Rankin, Julia L Newton, Mark Pearce in BMJ Open Volume 13, Issue 10, 2023
To identify, synthesise and appraise evidence relating to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and pregnancy.
Mixed-methods systematic review, using convergent segregated design.
MEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, MedRxiv, PROSPERO and grey literature sources through 6 August 2023.
We included original research studies, expert opinion and grey literature reporting on ME/CFS and pregnancy/post partum (up to 2 years), risk of pregnancy outcomes with ME/CFS or experiences during pregnancy for mother, partner or health and social care professionals following ME/CFS during pregnancy, all where the evidence was relevant to a confirmed ME/CFS diagnosis prior to pregnancy.
Data extraction and synthesis
Three independent reviewers completed all screening, data extraction and quality assessment. Risk of bias was assessed using the mixed-methods appraisal tool V.2018. Qualitative and quantitative literature was analysed separately using thematic and descriptive syntheses. Findings were integrated through configuration.
Searches identified 3675 articles, 16 met the inclusion criteria: 4 quantitative (1 grey), 11 qualitative (9 grey) and 1 grey mixed-methods study. Of the four quantitative studies that reported on ME/CFS severity during pregnancy:
- two suggested pregnancy negatively impacted on ME/CFS
- one found most women had no change in ME/CFS symptoms and
- one found ME/CFS improved;
this difference in symptom severity across studies was supported by the qualitative evidence.
The qualitative literature also highlighted the importance of individualised care throughout pregnancy and birth, and the need for additional support during family planning, pregnancy and with childcare.
Only one quantitative study reported on pregnancy outcomes, finding decreased vaginal births and higher rates of spontaneous abortions and developmental and learning delays associated with pregnancies in those with ME/CFS.
Current evidence on ME/CFS in pregnancy is limited and findings inconclusive. More high-quality research is urgently needed to support the development of evidence-based guidelines on ME/CFS and pregnancy.
STRENGTHS AND LIMITATIONS OF THIS STUDY
- Thorough and systematic search for both peer-reviewed and grey literature relating to myalgic encephalomyelitis/ chronic fatigue syndrome and pregnancy that was not limited by date of publication.
- Inclusion of both qualitative and quantitative evidence from both peer-reviewed and grey literature sources allowed us to explore different aspects of a complex research question.
- Limited evidence was available, particularly peer-reviewed literature, which restricted the conclusions we were able to make in this study.