Family Planning in Neuroinflammatory Disease

This article provides evidence-based advice to facilitate early, explicit, and continuous consideration of family planning, enabling effective treatment selection and allowing people living with neuroinflammatory disorders to balance disease control with optimal pregnancy outcomes.

There has been a paradigm shift in treatment approaches for women living with active neuroinflammatory disease who are considering pregnancy. Women with active multiple sclerosis are at risk of disabling relapse if immunosequestering therapy is withdrawn for pregnancy, making it essential that pregnancies are well planned. For those taking CD20-antibody or induction therapies, relapse rates remain suppressed during pregnancy with low postpartum relapse risk, even when treatment is discontinued during pregnancy and not directly restarted after birth. In patients with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), CD20 antibodies are increasingly used around pregnancy, with additional promising early data regarding the safety of eculizumab and interleukin-6 antibodies. All monoclonal antibodies used in multiple sclerosis, NMOSD, and MOGAD are potentially suitable for use during breastfeeding, particularly in women with more active prepregnancy disease, due to low rates of breakthrough relapses combined with an absence of breastmilk transfer.

Balancing disease control with pregnancy and neonatal considerations in people with neuroinflammatory disease throughout the family planning, pregnancy, and postpartum periods is crucial. Modern treatment paradigms enable women to safely become pregnant and breastfeed alongside effective disease management. Shared decision-making is an important part of this process.