Reproductive issues and multiple sclerosis: 20 questions

Abstract

Multiple sclerosis (MS) is commonly diagnosed in young adults during their reproductive years. Consequently, concerns about family planning and MS management related to pregnancy and breastfeeding are often encountered in clinical practice. Pregnancy itself is not harmful for women with MS. However, disease-modifying therapies (DMTs) have implications for reproductive planning, including stopping treatment while trying to conceive and during pregnancy, as well as managing fetal risks. People with MS and their care team must engage in collaborative decision-making before, during, and after pregnancy. Based on the results of a consensus-building initiative, answers are provided to 20 frequently asked questions regarding the management of MS during pregnancy planning, pregnancy, and the postpartum period. KEY POINTSMost women with MS can conceive, have normal pregnancies and deliveries, and breastfeed successfully.Primary considerations relate to ensuring proper prenatal counseling about cessation of DMT and timing of conception, as well as resumption of DMT.To engage in collaborative decision-making throughout all stages of pregnancy, clinicians caring for people with MS need to be familiar with pregnancy-related risks associated with MS therapies, as well as the management of MS-related reproductive issues.

Disease-Modifying Therapies (DMTs) in Pregnant and Lactating Women with Multiple Sclerosis: Analysis of Real-World Data from EudraVigilance Database

“…Natalizumab should be stopped 2-3 months before conception. However, natalizumab can be continued in some circumstances (such as in patients with more active or refractory disease) until 30-34 weeks because evidence showed a higher risk of MS relapse during these special conditions and also because it does not cross the placental barrier during the first trimester of pregnancy [25][26][27]. In our study, glatiramer was the second most reported DMT, probably due to its safety in pregnancy and breastfeeding, as evaluated by regulatory agencies.…”

“…In our study, most ICSRs referred to natalizumab probably because this drug was associated with a higher use during pregnancy than the other DMTs. All DMTs should have the recommended washout periods before planned conception or should be stopped when unplanned pregnancy is confirmed [25,26]. Natalizumab should be stopped 2-3 months before conception.…”

Drugs Targeting CD20 in Multiple Sclerosis: Pharmacology, Efficacy, Safety, and Tolerability

“…In select cases of women with highly active disease, a shorter interval may be considered to reduce time off therapy. These patients may discontinue contraception to attempt to become pregnant 1–3 months after rituximab or ocrelizumab, as they are eliminated by 3.5–4.5 months after dosing based on half-lives [ 75 ]. Because there is minimal placental transfer of IgG during the first trimester [ 76 ], if a woman conceives 1–3 months after the last dose of therapy, the risk of fetal exposure is low [ 77 ].…”

Male sexual and reproductive health in multiple sclerosis: a scoping review

“…Following recent reviews focused on female reproductive and sexual health in MS [ 20 , 24 , 31 ], we conducted a scoping review to evaluate the available literature on male reproductive and sexual health in MS. Such a comprehensive summary will facilitate current knowledge synthesis and identify existing gaps in the literature, which will guide next steps in enhancing MS clinical care and research related to male sexual and reproductive health in MS.…”