Treatment of multiple sclerosis during pregnancy - safety considerations.
Women with multiple sclerosis (MS) are treated early in the disease course with disease modifying therapies (DMT). Updated information is needed on pregnancy outcomes of DMT-exposed pregnancies and the effect of the drug withdrawal on MS disease activity. Areas covered: In this review, we will cover the most important updated management strategies in planning a pregnancy when having MS. Expert opinion: MS itself does not increase the risk of adverse pregnancy outcomes and does not negatively influence the long-term course of the disease. As MS became a treatable disease, management of DMTs before, during and after pregnancy is important. This requires updated knowledge on safety of DMTs as well as data of the effect on disease activity after drug withdrawal. A special challenge is the handling of women with highly active MS, as pregnancy might not be powerful enough to suppress the risk of rebound relapses. Exclusive breastfeeding is an option for many women who want to do so, but in cases of high disease activity and those women who do not want to breastfeed, early reintroduction of MS therapies should be considered.
a Department of Neurology , University Hospital Essen , Essen , Germany.
Jan
J
Thöne
b Department of Neurology, St. Josef-Hospital , Ruhr-University Bochum , Bochum , Germany.
Sandra
S
Thiel
b Department of Neurology, St. Josef-Hospital , Ruhr-University Bochum , Bochum , Germany.
Ralf
R
Gold
b Department of Neurology, St. Josef-Hospital , Ruhr-University Bochum , Bochum , Germany.
Kerstin
K
Hellwig
D000818:Animals; D001942:Breast Feeding; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000503:physiopathology; D011256:Pregnancy Outcome
D007166:Immunosuppressive Agents
Abortion; adverse events; fetal abnormalities; teratogenetic effects