While pregnancy does not appear to affect the disease course of multiple sclerosis (MS), questions remain about the best time to stop or resume treatment before conception and after delivery, the safety of new medications, and the importance of family planning.
Pregnancy was the “hot topic” discussion today in a session, titled “MS Pregnancy in the treatment era,” at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), which is being held Sept. 11–13 in Stockholm, Sweden.
Three presentations focused on different aspects of pregnancy, including the risks for the mother and child, and the importance of early counseling for patients wishing to become parents.
Until the 1980s, women with MS were discouraged from having children due to the false belief that pregnancy would worsen their disease course.
A shift in knowledge occurred in 1998 when the PRIMS study (Pregnancy in Multiple Sclerosis multicenter European study) showed that, overall, pregnancy did not affect the long-term clinical course of MS. In fact, the study provided evidence that relapse rates go down during pregnancy in MS women, and then restart after giving birth — of note, relapses can get particularly worse in the first three months after delivery.
The PRIMS study also showed that disability progression is similar between pregnant MS women and the general MS population, suggesting that the overall impact of pregnancy on MS course seems to be neutral.
However, over the last three decades, the emergence of a variety of disease-modifying therapies (DMTs) has raised many questions about the risks of each therapy for the fetus, and about which medicines to stop or restart and when to do so.
The mother’s perspective
As some DMTs can harm the fetus, many women with MS worry about the risks of taking medications while trying to get pregnant. Also, given the limited information about the treatments’ safety, most physicians are reluctant to prescribe them to women planning to conceive.
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