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      Pregnancy and multiple sclerosis: an update

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          Abstract

          Purpose of review

          To provide the latest evidence and treatment advances of multiple sclerosis in women of childbearing age prior to conception, during pregnancy and postpartum.

          Recent findings

          Recent changes permitting interferon beta (IFN-β) use in pregnancy and breastfeeding has broadened the choices of disease modifying treatments (DMTs) for patients with high relapse rates. Natalizumab may also be continued until 34 weeks of pregnancy for patients requiring persisting treatment. Drugs with a known potential of teratogenicity such as fingolimod or teriflunomide should be avoided and recommended wash-out times for medications such as cladribine, alemtuzumab or ocrelizumab should be considered. Teriflunomide and fingolimod are not recommended during breastfeeding, however, glatiramer acetate and IFN-β are considered to be safe.

          Summary

          The evidence of potential fetotoxicities and adverse pregnancy outcomes associated with DMTs is increasing, although more research is needed to evaluate the safety of drugs and to track long-term health outcomes for the mother and the child.

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          Most cited references32

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          Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group.

          M Hours, Darek T. R. Moreau, P Tourniaire … (1998)
          Multiple sclerosis often occurs in young women, and the effect of pregnancy on the disease is poorly understood. We studied 254 women with multiple sclerosis during 269 pregnancies in 12 European countries. The women were followed during their pregnancies and for up to 12 months after delivery to determine the rate of relapse per trimester and the score on the Kurtzke Expanded Disability Status Scale (range, 0 to 10, with higher scores indicating more severe disability). The relapse rate in each trimester was compared with the rate during the year before the pregnancy. The effects of epidural analgesia and breast-feeding on the frequency of relapse during the first three months post partum and the disability score at 12 months post partum were also determined. The mean (+/-SD) rate of relapse was 0.7+/-0.9 per woman per year in the year before pregnancy; it was 0.5+/-1.3 during the first trimester (P=0.03 for the comparison with the rate before pregnancy), 0.6+/-1.6 during the second trimester (P=0.17), and 0.2+/-1.0 during the third (P<0.001). The rate increased to 1.2+/-2.0 during the first three months post partum (P<0.001) and then returned to the prepregnancy rate. The mean Kurtzke disability score worsened by 0.7 point during 33 months of follow-up, with no apparent acceleration during the post-partum period. Neither breast-feeding nor epidural analgesia had an adverse effect on the rate of relapse or on the progression of disability in multiple sclerosis. In women with multiple sclerosis, the rate of relapse declines during pregnancy, especially in the third trimester, and increases during the first three months post partum before returning to the prepregnancy rate.
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            UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines

            Ruth Dobson, Pooja Dassan, Megan Y Roberts … (2019)
            Multiple sclerosis (MS) is more common in women than men and is most commonly diagnosed in early adulthood; thus, many patients will not have completed their families at the time of diagnosis. There is increasing awareness of the importance of early treatment in preventing long-term disability in MS. Delaying treatment until women with MS have completed their families can lead to the development of irreversible disability in at least some cases. It is therefore important to discuss family planning and pregnancy proactively. However, to date there is limited evidence to inform such discussions. We set out to develop consensus guidelines for the treatment of MS in pregnancy to encourage and facilitate discussions in this important area. The guidelines draw on available evidence from drug-specific pregnancy registers and published literature and have been scored by a panel of experts from a variety of disciplines using modified Delphi criteria. They cover prepregnancy counselling, management during pregnancy, delivery and anaesthetic options, postpartum advice and specific advice regarding currently licensed disease-modifying drugs. As the complexity and range of available disease-modifying drugs increase, further data gathering via a UK-wide MS pregnancy register is recommended.
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              Pregnancy outcomes in the clinical development program of fingolimod in multiple sclerosis.

              Goeril Karlsson, Gordon Francis, Gideon Koren … (2014)
              To report outcomes of pregnancies that occurred during the fingolimod clinical development program.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Curr Opin Obstet Gynecol
                Journal ID (iso-abbrev): Curr Opin Obstet Gynecol
                Journal ID (publisher-id): COOGY
                Title: Current Opinion in Obstetrics & Gynecology
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 1040-872X
                ISSN (Electronic): 1473-656X
                Publication date (Print): October 2021
                Publication date (Electronic): 22 July 2021
                Volume: 33
                Issue: 5
                Pages: 378-383
                Affiliations
                Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
                Author notes
                Correspondence to Audronė Arlauskienė, M. K. Čiurlionio st. 21, Vilnius, Lithuania. Tel: +370 6 8717204; e-mail: audrone.arlauskiene@ 123456santa.lt
                Article
                Publisher ID: GCO330501 Accession ID: 00004
                DOI: 10.1097/GCO.0000000000000731
                PMC ID: 8452312
                PubMed ID: 34310364
                SO-VID: 3b57b466-b512-4589-a742-2e8db7087d57
                Copyright © Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0

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                Categories
                Subject: WOMEN’S HEALTH: Edited by Joseph Aquilina
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: breastfeeding,disease modifying treatment,multiple sclerosis,pregnancy
                Data availability:
                Keywords: breastfeeding, disease modifying treatment, multiple sclerosis, pregnancy

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