There are increasing data that delaying starting disease-modifying drugs and/or routinely stopping all disease-modifying drugs prepregnancy or immediately postconception is associated with increased relapse rate during pregnancy.
This can have significant negative effects on long-term disability in women with multiple sclerosis ( MS ).
Consideration should be given regarding the potential for future pregnancies when starting women of childbearing age on disease-modifying drugs.
Counselling around disease-modifying drugs and symptomatic medication in pregnancy needs to happen before the woman stops contraception where possible.
There are potential issues around pregnancy in women with advanced multiple sclerosis or significant cognitive impairment, which should be discussed on an individual patient basis and are beyond the scope of these guidelines.
First-line injectable treatments, such as Glatiramer acetate and beta Interferon, may be continued during pregnancy.
Patients taking Natalizumab will usually have had highly active disease before treatment, and serious consideration should be given to continuing treatment during pregnancy given the significant risk of disease reactivation and/or rebound on stopping treatment.
Pregnancy is not recommended for 4 months following Alemtuzumab and for 6 months following treatment with Cladribine; however after this time there are no contraindications.
It is not recommended to try to conceive for 12 months after receiving ocrelizumab; because this medication is given on a 6-monthly basis, family planning must be considered when initiating and prescribing.
Teriflunomide is contraindicated in pregnancy, and Dimethyl fumarate and Fingolimod should be avoided where possible.
An independent pregnancy register of all women with multiple sclerosis who become pregnant, with prospective data collection on all medications and pregnancy-related outcomes is much needed. ( Xagena )
Dobson R et al, Pract Neurol 2019; 0:1–9. doi:10.1136/practneurol-2018-002060