title: Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks.
abstract: The burden of multiple sclerosis (MS) in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs), which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-βappears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation.
authors.affiliation: Division of Neurology, Amiri Hospital and Division of Neurology, Dasman Diabetes Institute, Dasman, Kuwait.
authors.forename: Raed
authors.identifier: 0000-0001-5436-5804
authors.initials: R
authors.lastname: Alroughani
authors.affiliation: Division of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Altintas
authors.affiliation: King Abdullah International Medical Research Center, King Saud Ben Abdulaziz University for Health Sciences, NGHA, Riyadh, Saudi Arabia; KFMC, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Jumah
authors.affiliation: MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Sahraian
authors.affiliation: Clinical Neurosciences Department, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Issa
authors.initials: I
authors.lastname: Alsharoqi
authors.affiliation: Neurology Section, King Khalid University Hospital, King Saud University and Dallah Hospital, Riyadh, Saudi Arabia.
authors.forename: Abdurahman
authors.initials: A
authors.lastname: AlTahan
authors.affiliation: King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdulkader
authors.identifier: 0000-0002-9026-0476
authors.initials: A
authors.lastname: Daif
authors.affiliation: Department of Internal Medicine, Neurology Section, Arab Medical Center and Khalidi Hospital, Amman, Jordan.
authors.forename: Maurice
authors.initials: M
authors.lastname: Dahdaleh
authors.affiliation: Department of Neurology (Medicine), Hamad Medical Corporation, Doha, Qatar.
authors.forename: Dirk
authors.initials: D
authors.lastname: Deleu
authors.affiliation: Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Fernandez
authors.affiliation: Laboratory of Experimental Neurology and Neuroimmunology, Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Nikolaos
authors.identifier: 0000-0003-4706-4637
authors.initials: N
authors.lastname: Grigoriadis
authors.affiliation: Neurology Department, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, UAE.
authors.forename: Jihad
authors.initials: J
authors.lastname: Inshasi
authors.affiliation: Department of Neurology, Neuroimmunology Unit, Hacettepe University Hospitals, Ankara, Turkey.
authors.forename: Rana
authors.initials: R
authors.lastname: Karabudak
authors.affiliation: Merck, Intercontinental Region, Dubai, UAE.
authors.forename: Karim
authors.initials: K
authors.lastname: Taha
authors.affiliation: Department of Neurology, 1st St. Petersburg State Medical University n.a. I.P. Pavlov, St. Petersburg, Russia.
authors.forename: Natalia
authors.initials: N
authors.lastname: Totolyan
authors.affiliation: Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Bassem I
authors.initials: BI
authors.lastname: Yamout
authors.affiliation: Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Magd
authors.initials: M
authors.lastname: Zakaria
authors.affiliation: Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Saeed
authors.initials: S
authors.lastname: Bohlega