Multiple sclerosis – a dynamic field with a need for excellent education
Although pregnancy in women with multiple sclerosis (MS) is not generally
considered high risk, there are some associated therapeutic challenges. The
pregnancy-associated reduction in the relapse rate, especially in the third trimester, is followed by a sharp increase in the first few months postpartum.
Nevertheless, retrospective evidence for pregnant women with and without MS followed for up to 10 years indicates that pregnancy has no perceptible effect on long-term disease course or disability progression. Likewise, MS has no apparent effects on the pregnancy course or fetal outcomes. All diseasemodifying therapies (DMTs) have potential adverse effects on fertility and pregnancy outcomes, but the level of risk varies amongst agents. There is some support for continued use of interferon-b and glatiramer acetate throughout pregnancy to reduce the risk of relapse. Use of DMTs during breastfeeding is best avoided if possible. Close evaluation of drug safety information is imperative when managing women with MS who are pregnant or wish to become pregnant. Decision-making should be a shared experience between patient and nd physician, and the approach must be individualized for each patient.
Source: European Journal of Neurology 2015, 22 (Suppl. 2): 34-39