Abstract
Purpose of this Review: This article is a systematic review on the influence pregnancy has on multiple sclerosis and the resulting impact of disease-modifying therapies.Findings: Multiple sclerosis predominantly affects young women with a clinical onset most often during the child-bearing age. The impact of multiple sclerosis and disease-modifying therapies on fertility, pregnancy, fetal outcome, and breastfeeding is a pivotal topic when it comes to clinical practice. The introduction of disease-modifying therapies has changed not only the natural history of the disease but also the perspective of pregnancy in women with multiple sclerosis. Family planning requires careful consideration, especially because many disease-modifying drugs are contraindicated during pregnancy. In this article, we review current evidence collected from published literature and drug-specific pregnancy registers on the use of disease-modifying therapies. Additionally, we discuss safety profiles for each drug and correlate them to both risk for the exposed fetus and risk for the mothers interrupting treatments when seeking pregnancy.
Highlights
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system with a chronic course, mainly affecting young women, the majority of whom are of childbearing age.Several factors have been suggested to explain the progressive increase in MS incidence in adult women in the last 30 years, including interactions between genes and environment, lifestyle modifications, older age at the birth of the first child, younger age at the menarche, or fewer pregnancies during a woman’s lifetime [1,2,3,4].Until the end of the 1990s, women affected by MS were frequently falsely discouraged to undertake pregnancy
The German study on 201 pregnancies (76% treated with interferons or glatiramer acetate, 11% treated with natalizumab) and with a postpartum follow-up period of 1 year concluded that exclusive breastfeeding was associated with a lower risk of postpartum relapses, while the main factor predicting disease activity after delivery was the number of relapses during pregnancy [60]
In the following therapy section, we argue about current recommendations for each diseasemodifying therapy (DMT) in relation to breastfeeding
Summary
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system with a chronic course, mainly affecting young women, the majority of whom are of childbearing age. The progressive introduction of disease-modifying therapies (DMTs) has completely transformed the natural history of MS, improving the perspective of pregnancy in affected women. Pregnancy in MS and DMTs on the fetus, the influence of pregnancy on MS course, the impact of the disease on the mother’s ability to care for her baby, and the socioeconomic burden of the disease on the family [6]. All these reasons pose an extra challenge in guiding MS women in their fertile age in making choices about pregnancy [7]. MS, pregnancy, delivery, breastfeeding, newborn, disease-modifying therapy, and postpartum have been the main keywords we used to identify the most relevant studies on the topic
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