Abstract
Pregnancy rates are rapidly increasing among women of reproductive age diagnosed with multiple sclerosis (MS). Through pre-conception, pregnancy and post-partum periods, there is a need for disease control management, to decrease chances of MS relapses while avoiding potential risks to the mother and the fetus. However, pregnancy is not always compatible with the available highly effective MS treatments. This narrative review provides the aspects of pregnancy’s outcomes and the impact on disease activity, choices of anesthesia and the management of relapses during the pregnancy and breastfeeding period. Available disease modifying treatment is discussed in the article with new data supporting the strategy of continuing natalizumab after conception, as it is related to a decreased risk of MS relapses during the pregnancy and postpartum period.
Highlights
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, affecting the brain, spinal cord and optic nerves
Through the pre-conception, pregnancy and post-partum periods there is a need for disease control management to decrease chances of MS
According to the US Food and Drug Administration (FDA), the majority of drugs registered to treat MS are labeled as class C, meaning data of adverse effect was obtained in animal reproduction studies; despite the possible risk, pregnant women may benefit from the drug, but there is not enough reliable evidence and well-controlled studies in humans [20]
Summary
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, affecting the brain, spinal cord and optic nerves. MS presents in two clinical forms: relapsing multiple sclerosis, manifesting with inflammatory attacks causing deterioration of neurological symptoms, and progressive. The increasing number of MS among women of reproductive age remains a clinical issue, as the variety of disease modifying therapies (DMTs) holds possible side effects for the fetus and the woman before or after conceiving. Through the pre-conception, pregnancy and post-partum periods there is a need for disease control management to decrease chances of MS relapses while avoiding the potential risks to the mother and the fetus [6]. This article reviews the literature on the available evidence concerning pregnancy’s impact on disease activity, issues before conceiving, available disease modifying treatment and the management of relapses during the pregnancy and breastfeeding period, pregnancy’s outcomes and choices of anesthesia during labor and delivery
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