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Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review
Riley Bove1, Sura Alwan, Jan M Friedman
1Harvard Medical School and the Departments of Neurology and Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts; the Departments of Medical Genetics and Neurology, University of British Columbia, Vancouver, British Columbia, the Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, and the Department of Neurology, University of Alberta, Edmonton, Alberta, Canada; and St. Joseph Hospital Neurology Clinic, Ruhr University, Bochum, Germany.
Objective:
To examine the evidence guiding management of multiple sclerosis (MS) in reproductive-aged women.
Data Sources:
We conducted an electronic literature search using PubMed, ClinicalTrials.gov, and other available resources. The following keywords were used: "multiple sclerosis" and "pregnancy." We manually searched the reference lists of identified studies.
Methods Of Study Selection:
Two reviewers categorized all studies identified in the search by management topic, including effect of pregnancy on MS course, fetal risks associated with disease-modifying treatments during pregnancy, and management of patients off disease-modifying treatment. We categorized studies by strength of evidence and included prior meta-analyses and systematic studies. These studies were then summarized and discussed by an expert multidisciplinary team.
Tabulation, Integration, And Results:
The risk of MS relapses is decreased during pregnancy and increased postpartum. Data are lacking regarding the risks of disease-modifying treatments during pregnancy. There may be an increased risk of MS relapses after use of assisted reproductive techniques. There does not appear to be a major increase in adverse outcomes in newborns of mothers with MS.
Conclusion:
Although there are many unmet research needs, the reviewed data support the conclusion that in the majority of cases, women with MS can safely choose to become pregnant, give birth, and breastfeed children. Clinical management should be individualized to optimize both the mother's reproductive outcomes and MS course.
