Multiple Sclerosis and pregnancy: balancing treatment, safety and family planning

Pregnancy and family planning remain important considerations in the management of Multiple Sclerosis (MS), particularly as treatment options become more effective and diverse.

In this expert session, Thomas Berger reviews how different disease-modifying therapies (DMTs) can influence decisions before, during and after pregnancy, and highlights the importance of evidence-based counselling, individualized treatment planning and careful consideration of breastfeeding.

Key Insights from the Lecture:

• Pregnancy itself is not presented as the main risk for women with Multiple Sclerosis; treatment exposure and timing are central considerations.
• Disease-modifying therapy decisions should take into account disease activity, treatment characteristics, pregnancy plans and the individual patient’s priorities.
• Injectable therapies such as interferons and glatiramer acetate are discussed as having the longest safety experience and are not necessarily contraindicated during pregnancy.
• Dimethyl fumarate may be continued until pregnancy is confirmed, although continuation during pregnancy is generally not recommended.S1P receptor modulators are contraindicated during pregnancy and require pre-pregnancy planning and treatment interruption.
• Cladribine may be considered in family planning strategies because of its cyclical dosing, but pregnancy should be avoided for a defined period after treatment.Natalizumab may be continued in selected patients when the benefit-risk balance supports it, particularly in those with highly active disease.
• Stopping high-efficacy treatment too early before conception may increase the risk of disease reactivation.
• Anti-CD20 therapies require careful timing because washout periods and B-cell reconstitution differ between treatments and recommendations may vary between regions.Breastfeeding remains an area with more limited evidence for several DMTs, and recommendations may therefore be more restrictive.
• Treatment decisions should balance disease control with the patient’s reproductive goals, including the postpartum period.
• Counselling and shared decision-making are essential, as pregnancy planning is not always predictable and recommendations must be adapted to the individual situation.

“Multiple Sclerosis and pregnancy: balancing treatment, safety and family planning”.

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About the speaker:

Thomas Berger

Professor of Neurology and Chair of the Dept. of Neurology at the Medical University of Vienna 

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