Natalizumab intake during pregnancy in women with multiple sclerosis: a meta-analysis of current evidence

Abstract

Background: Disease-modified therapy has changed the previous practice of discontinuing multiple sclerosis (MS) treatment for fear of side effects that might impact pregnancy. Many studies have described the use of natalizumab as a medicinal agent during pregnancy, with mixed results regarding its safety and efficacy during pregnancy. For instance, this study aimed to investigate the pregnancy outcomes in pregnant women with MS who took natalizumab during the pregnancy period. Methods: A systematic literature search was conducted during July 2023, adhering to the PRISMA guidelines. Five databases were included: PubMed, Google Scholar, Web of Science, Virtual Health Library, and Scopus. The following keywords were employed in the search "multiple sclerosis," "pregnancy," "pregnancies, "pregnant," and "natalizumab." Results: Only eight papers out of 1,000 total records were included. No significant difference between natalizumab and the control group in terms of abortion, C-section, preterm birth, congenital abnormalities, or birth height was found (p > 0.05). However, the natalizumab-treated group had a significantly lower birth weight than the control group [Mean difference = -97.89; 95% confidence interval (CI) = -171.32, -24.45], with 82.7% relapse rate (95% CI = 72.1-89.8), being highest in the second trimester (24.9%; 95% CI = 7.4, 58.0). Conclusion: While Natalizumab treatment appears to be relatively safe in terms of abortion rates, C-section rates, preterm delivery rates, and congenital anomalies, the increased relapse rate during pregnancy and lower birth weight observed necessitate careful monitoring and individualized care for pregnant MS patients taking natalizumab.