Pregnancy decision-making in women with multiple sclerosis treated with natalizumab

Portaccio, Emilio; Moiola, Lucia; Martinelli, Vittorio; Annovazzi, Pietro; Ghezzi, Angelo; Zaffaroni, Mauro; Lanzillo, Roberta; Morra, Vincenzo Brescia; Rinaldi, Francesca; Gallo, Paolo; Tortorella, Carla; Paolicelli, Damiano; Pozzilli, Carlo; Giglio, Laura De; Cavalla, Paola; Cocco, Eleonora; Marrosu, Maria Giovanna; Solaro, Claudio; Uccelli, Antonio; Laroni, Alice; Pastò, Luisa; Giannini, Marta; Trojano, María; Comi, Giancarlo; Amato, Maria Pia

doi:10.1212/wnl.0000000000005068

Cited by 77 publications

(122 citation statements)

References 23 publications

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“…Wie hoch das Risiko für MSSchübe in der Schwangerschaft bei Absetzen des DMT vor der Konzeption ist, kann nicht eindeutig beantwortet werden. Es gibt Anhaltspunkte dafür, dass das Risiko für MSSchübe umso höher ist, je länger die Auswaschperiode vor der Schwangerschaft ist und je effektiver die abgesetzte Therapie war [3,4]. Bei geplanter Schwangerschaft und hohem Risiko einer Krankheitsreaktivierung wird eine Therapie mit BetaInterferonen (IFNbeta) oder Glatirameracetat (GLAT) bis zum Eintritt der Schwangerschaft empfohlen.…”

Section: Schwangerschaft Und Dmtunclassified

Kinderwunsch bei Multipler Sklerose

Hellwig¹,

Wilkening²

2020

Nervenheilkunde

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Section: Schwangerschaft Und Dmtunclassified

Kinderwunsch bei Multipler Sklerose

Hellwig¹,

Wilkening²

2020

Nervenheilkunde

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“…Table provides a summary of the safety of the use of MS medications during pregnancy and breastfeeding to maintain disease remission and treat acute flare . Definitions of the US Food and Drug Administration (FDA) categories are shown in Box 2.…”

Section: Safety Of the Use Of Ms Medications During Pregnancy And Brementioning

confidence: 99%

Multiple sclerosis and pregnancy

Kanagaraj

Evangelou

Kapoor

2019

The Obstetric & Gynaecologis

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Multiple sclerosis (MS) is a chronic neurological disease that manifests with clinical and subclinical attacks of central nervous system demyelination. Women are at least twice as likely as men to develop MS, with a mean age of onset of 30 years. Pregnancy has no adverse long-term effect on disease progression, but it is associated with a higher relapse rate in the immediate postpartum period. Pregnancy can worsen pre-existing urinary/bowel dysfunction and motor problems. MS is not associated with significant obstetric or neonatal complications. Learning objectivesTo understand how to manage pregnant women with MS in the multidisciplinary setting.To understand the importance of pre-pregnancy counselling for women with MS who are on disease-modifying drugs. To understand the implications of pregnancy on MS symptoms and their management. To be aware of the benefits of breastfeeding and the safety of disease-modifying drugs and lactation. Ethical issuesIn the absence of clear guidelines, should women ever be advised to avoid pregnancy? Should women be offered in vitro fertilisation treatment, which is known to increase disease relapse?

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“…The natural reduction of relapses that occurs during pregnancy may not be sufficient to control disease activity, particularly in those with highly active disease. Withdrawal of some of the more highly efficacious disease-modifying drugs has been associated with a return of disease activity and rebound 3…”

Section: Introductionmentioning

confidence: 99%

UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines

et al. 2019

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Multiple sclerosis (MS) is more common in women than men and is most commonly diagnosed in early adulthood; thus, many patients will not have completed their families at the time of diagnosis. There is increasing awareness of the importance of early treatment in preventing long-term disability in MS. Delaying treatment until women with MS have completed their families can lead to the development of irreversible disability in at least some cases. It is therefore important to discuss family planning and pregnancy proactively. However, to date there is limited evidence to inform such discussions. We set out to develop consensus guidelines for the treatment of MS in pregnancy to encourage and facilitate discussions in this important area. The guidelines draw on available evidence from drug-specific pregnancy registers and published literature and have been scored by a panel of experts from a variety of disciplines using modified Delphi criteria. They cover prepregnancy counselling, management during pregnancy, delivery and anaesthetic options, postpartum advice and specific advice regarding currently licensed disease-modifying drugs. As the complexity and range of available disease-modifying drugs increase, further data gathering via a UK-wide MS pregnancy register is recommended.

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Pregnancy decision-making in women with multiple sclerosis treated with natalizumab

Abstract: This study provides Class IV evidence that in women with MS, the risk of relapses during pregnancy is higher in those who had been using natalizumab as compared to those who had been using interferon-β or no treatment.

Cited by 77 publications

References 23 publications

Kinderwunsch bei Multipler Sklerose

Kinderwunsch bei Multipler Sklerose

Multiple sclerosis and pregnancy

UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines

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