Natalizumab Use During the Third Trimester of Pregnancy

Haghikia, Aiden; Langer‐Gould, Annette; Rellensmann, Georg; Schneider, Hans‐Jürgen; Tenenbaum, Tobias; Elias-Hamp, Birte; Menck, Sylvia; Zimmermann, Julian; Herbstritt, Sandra; Marziniak, Martin; Kümpfel, Tania; Meinl, Ingrid; Plavina, Tatiana; Gold, Ralf; Hellwig, Kerstin

doi:10.1001/jamaneurol.2014.209

Cited by 173 publications

(131 citation statements)

References 21 publications

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“…It is not typically used by nursing mothers. Natalizumab has been used during pregnancy without notable teratogenicity, but newborns may experience transient hematologic abnormalities including anemia and thrombocytopenia [Haghikia et al 2014]. One study noted an immune disturbance (abnormal lymphocyte chemotaxis) in two exposed neonates [Schneider et al 2013].…”

Section: Disease-modifying Therapiesmentioning

confidence: 99%

Management of women with multiple sclerosis through pregnancy and after childbirth

Coyle

2016

Ther Adv Neurol Disord

121

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Multiple sclerosis (MS) is a major acquired neurologic disease of young adults. The prototypic patient is a young woman of reproductive age. Gender preference is becoming more pronounced, since MS is increasing specifically among women. Any healthcare provider who deals with MS must be prepared to discuss pregnancy issues, and provide appropriate counseling. This is now complicated by the availability of multiple treatment options. There is growing literature on which to base recommendations, particularly regarding washout periods. After a brief background introduction, this review will discuss state-of-the-art family planning counseling in the treatment era, divided into prepregnancy, pregnancy, and postpartum MS issues.

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Section: Disease-modifying Therapiesmentioning

confidence: 99%

Management of women with multiple sclerosis through pregnancy and after childbirth

Coyle

2016

Ther Adv Neurol Disord

121

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“…As such, only experienced MS centers should treat pregnant women with natalizumab during pregnancy and only after careful risk-benefit consideration. It is recommended that a paediatrician be in attendance during delivery and that blood cell count, liver enzymes, haptoglobin and bilirubin be controlled in the newborn [7]. …”

Section: Pregnancy and Disease-modifying Treatmentsmentioning

confidence: 99%

Pregnancy in Multiple Sclerosis

Hellwig

2014

Eur Neurol

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Background: The incidence of multiple sclerosis (MS) is increasing, particularly in young women (20−40 years). In line, experience in the management of pregnancies and use of disease-modifying therapy (DMT) in women with MS is accumulating. Summary: Fertility is generally not affected in MS. If assisted reproduction techniques (ART) are required, unsuccessful procedures are associated with an increased relapse risk, particularly in the first few months post-ART. During pregnancy, the risk of relapse declines continuously, especially in the third trimester, then increases early postpartum (3 months) and returns to pre-pregnancy levels at 4−6 months. The progression of MS disability is probably not influenced by pregnancy. Obstetrical outcomes show no increased risk for miscarriage/malformations, and the course of pregnancy is similar to that of women without MS, but with a tendency towards assisted delivery/cesarean section and reduced birth weights. Safety data regarding DMT in pregnancy and breastfeeding are limited. Exclusive breastfeeding may be beneficial and, hence, should not be discouraged in favour of resuming DMT except in cases of highly-active disease. Key Messages: The course of pregnancy in women with MS is broadly similar to that in women without MS; risk-to-benefit assessments are warranted when considering halting DMT before pregnancy and resuming DMT postpartum.

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“…Another study reported mild-to-moderate haematological alterations (mainly thrombocytopenia and anaemia) in 10 of 13 infants whose mothers received natalizumab during the third trimester of pregnancy [122].…”

Section: Pregnancy and Foetal Developmentmentioning

confidence: 99%

Fertility, Pregnancy and Childbirth in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs

Amato

Portaccio

2015

CNS Drugs

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In recent decades, pregnancy-related issues in multiple sclerosis (MS) have received growing interest. MS is more frequent in women than in men and typically starts during child-bearing age. An increasing number of disease-modifying drugs (DMDs) for the treatment of MS are becoming available. Gathering information on their influences on pregnancy-related issues is of crucial importance for the counselling of MS patients. As for the immunomodulatory drugs (interferons and glatiramer acetate), accumulating evidence points to the relative safety of pregnancy exposure in terms of maternal and foetal outcomes. In case of higher clinical disease activity before pregnancy, these drugs could be continued until conception. As for the 'newer' drugs (fingolimod, natalizumab, teriflunomide, dimethyl fumarate and alemtuzumab), the information is more limited. Whereas fingolimod and teriflunomide are likely associated with an increased risk of foetal malformations, the effects of natalizumab, dimethyl fumarate and alemtuzumab still need to be ascertained. This article provides a review of the available information on the use of DMDs during pregnancy, with a specific focus on fertility, foetal development, delivery and breast-feeding.

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Natalizumab Use During the Third Trimester of Pregnancy

Cited by 173 publications

References 21 publications

Management of women with multiple sclerosis through pregnancy and after childbirth

Management of women with multiple sclerosis through pregnancy and after childbirth

Pregnancy in Multiple Sclerosis

Fertility, Pregnancy and Childbirth in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs

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