[How to manage medical treatment during pregnancy and childbirth]

Generally, development of multiple sclerosis (MS) is during the childbearing age. Therefore, pregnancy and delivery are major issues in patients with MS. The Pregnancy in MS study reported that the annual relapse rate decreases during pregnancy and increases during the first 3 months after delivery. Interferon-β (IFNβ) therapy is usually discontinued prior to pregnancy. IFNβ exposure was related to lower birth weight, however not observed any fetal complications or development abnormalities. Recently the new agents are used before pregnancy for MS. Fingolimod is teratogenic in rats. There is limited information on the safety of fingolimod in pregnancy. Natalizumab should not be used during pregnancy unless the clinical condition of the women requires treatment. Further studies are required to determine the potential risks associated with preconception and in utero disease-modifying-drug exposure in patients with MS. Neuromyelitis optica (NMO), recent larger scale studies consistently showed that relapse rate in NMO was significantly higher during the first 3 months postpartum as compared with before or during pregnancy.