Optimal management of multiple sclerosis during pregnancy: current perspectives

Area of Science:

• Neurology
• Immunology
• Reproductive Medicine

Background:

• Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
• MS predominantly affects women during their reproductive years, making family planning crucial.
• Managing MS during pregnancy and breastfeeding presents unique challenges for patient care and treatment.

Purpose of the Study:

• To review current data on pregnancy outcomes in women with MS.
• To assess the impact of pregnancy on the course of MS.
• To provide an updated overview of disease-modifying therapies (DMTs) for MS during pregnancy and breastfeeding.

Main Methods:

• Literature review of studies on pregnancy in MS patients.
• Analysis of data regarding the influence of pregnancy on MS disease activity.
• Evaluation of the safety and efficacy of various MS DMTs in the context of pregnancy and breastfeeding.

Main Results:

• Pregnancy may have a variable effect on the course of MS, with some studies suggesting a reduced relapse rate during pregnancy.
• Established MS therapies like interferon-beta, glatiramer acetate, natalizumab, and fingolimod have data regarding their use in pregnancy and breastfeeding.
• Emerging data on newer agents such as dimethyl fumarate, teriflunomide, and alemtuzumab in pregnant or breastfeeding MS patients are also discussed.

Conclusions:

• Informed counseling regarding family planning, pregnancy, and breastfeeding is essential for women with MS.
• The choice of MS treatment during pregnancy and breastfeeding should be individualized based on disease activity, drug-specific data, and patient preference.
• Further research is needed to fully elucidate the long-term effects of newer MS therapies on maternal and infant outcomes.