Use and safety of disease‐modifying therapy in pregnant women with multiple sclerosis

MacDonald, Sarah; McElrath, Thomas F.; Hernández–Dı́az, Sonia

doi:10.1002/pds.4735

Cited by 16 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The drugs that were studied the most were interferon, glatiramer acetate, natalizumab. There were very few patients included that were treated with fingolimod, azathioprine or rituximab, MacDonald et al [ 12 ] did not stratify their analyses by type of drug and only conducted their analyses as overall. Therefore, it was not possible to include their data in the drug-specific analyses.…”

Section: Resultsmentioning

confidence: 99%

“…The cases of polydactyly were present in β-interferon and natalizumab patients and the club foot in patients exposed to GA and natalizumab. The biggest study did not list the major malformations [ 12 ]. We contacted the authors and they stated that given that the study was performed in claims database it was not permitted to publish non-aggregated data.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 ConcePTION project

et al. 2020

View full text Add to dashboard Cite

Neurologists managing women with Multiple Sclerosis (MS) need information about the safety of disease modifying drugs (DMDs) during pregnancy. However, this knowledge is limited. The present study aims to summarize previous studies by performing a systematic review and meta-analyses. The terms “multiple sclerosis” combined with DMDs of interest and a broad profile for pregnancy terms were used to search Embase and Medline databases to identify relevant studies published from January 2000 to July 2019.1260 studies were identified and ten studies met our inclusion criteria. Pooled risk ratios (RR) of pregnancy and birth outcomes in pregnancies exposed to DMDs compared to those not exposed were calculated using a random effects model. For spontaneous abortion RR = 1.14, 95% CI 0.99–1.32, for preterm births RR = 0.93, 95% CI 0.72–1.21 and for major congenital malformations RR = 0.86, 95% CI 0.47–1.56. The most common major congenital malformations reported in MS patients exposed to MS drugs were atrial septal defect (ASD) (N = 4), polydactyly (N = 4) and club foot (N = 3), which are among the most prevalent birth defects observed in the general population. In conclusion, interferons, glatiramer acetate or natalizumab, do not appear to increase the risk for spontaneous abortions, pre-term birth or major congenital malformations. There were very few patients included that were exposed to fingolimod, azathioprine and rituximab; therefore, these results cannot be generalized across drugs. Future studies including internal comparators are needed to enable treating physicians and their patients to decide on the best treatment options.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 ConcePTION project

et al. 2020

View full text Add to dashboard Cite

show abstract

“…54 Conversely, women with MS may have an increased risk of infection during pregnancy, particularly genitourinary and upper respiratory infections. 53,58 The Impact of Pregnancy on MS Course The Impact of Pregnancy on the Short-Term Course of MS Most of the current knowledge about the evolution of MS during pregnancy and after delivery has been obtained from the multicenter Pregnancy in Multiple Sclerosis Study, [59][60][61] which was the first prospective study to explore the relationship between pregnancy and MS. This study included untreated women with MS, most of whom were in their first pregnancy.…”

Section: Effects Of Ms On Fertility Pregnancy and Childbirthmentioning

confidence: 99%

Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy

Villaverde-González¹

2022

DNND

View full text Add to dashboard Cite

Multiple sclerosis (MS) is a chronic immune-mediated, inflammatory, and degenerative disease that is up to three times more frequent in young women. MS does not alter fertility and has no impact on fetal development, the course of pregnancy, or childbirth. The Pregnancy in Multiple Sclerosis Study in 1998 showed that pregnancy, mostly in untreated women, did not adversely affect MS, as disease activity decreased during pregnancy (although it significantly increased in the first trimester postpartum). These findings, together with the limited information available on the potential risks of fetal exposure to disease modifying treatments (DMTs), meant that women were advised to delay the onset of DMTs, stop them prior to conception, or, in case of unplanned pregnancy, discontinue them when pregnancy was confirmed. Now, many women with MS receive DMTs before pregnancy and, despite being considered a period of MS stability, up to 30% of patients could relapse in the first trimester postpartum. Factors associated with an increased risk of relapse and disability during pregnancy and postpartum include relapses before and during pregnancy, a greater disability at the time of conception, the occurrence of relapses after DMT cessation before conception, and the use of high-efficacy DMTs before conception, especially natalizumab or fingolimod. Strategies to prevent postpartum activity are needed in some patients, but consensus is lacking regarding the therapeutic strategies for women with MS of a fertile age. This, along with the increasing number of DMTs, means that the decision-making processes in aspects related to family planning and therapeutic strategies before, during, and after pregnancy are increasingly more complex. The purpose of this review is to provide an update on pregnancy-related issues in women with MS, including recommendations for counseling, general management, use of DMTs in pre-pregnancy, pregnancy, and postpartum periods, and breastfeeding-related aspects of DMTs.

show abstract

“…33 A study of pregnant women with and without MS showed a higher incidence of lower respiratory tract infection (5.2% vs. 3.9%, respectively), but this difference did not reach statistical significance. 34 Houtchens et al, 32 using an administrative claims database, reported that women with MS had a higher risk of infection complicating pregnancy than women without MS. Using other databases, MacDonald et al 34 also found a higher risk of infection among women with MS, including a higher risk of genitourinary infections (aRR = 1.26 [1.17-1.36]) and upper respiratory tract infections (aRR = 1.33 [1.20-1.45]).…”

Section: Infectionmentioning

confidence: 99%

“…Studies of pregnant women with MS, however, showed no increased risk for hemorrhagical complications. 28,32,34…”

Section: Hemorrhagementioning

confidence: 99%

The Intersection of Disability and Pregnancy: Risks for Maternal Morbidity and Mortality

Signore

Davis

Tingen

et al. 2021

Journal of Women's Health

View full text Add to dashboard Cite

It is estimated that 1 in 4 women in the United States live with a disability, and using population-based estimates, 10–12% of women of childbearing age have a disability. There are limited data to suggest that women with disabilities experience higher rates of or risks for adverse outcomes related to pregnancy, delivery, and access to appropriate postpartum care. Research on specific disabling conditions demonstrates variable risk for syndromes that threaten the health of the mother, such as preeclampsia, infection, and coagulation disorders. Much of the literature suggests that normal, healthy pregnancy is possible but points to the need for tailored information for patients and providers about the intersection of their condition with pregnancy and specific care needs. Given the lack of systematic evidence in this area across conditions and functional impairments, more research is needed to clarify the interaction of specific disabilities with pregnancy and provide evidence-based information to the field to decrease the risks to mothers and their infants. This article will provide an overview of conditions that contribute to maternal morbidity and mortality as they relate to pregnancy in women with disabilities and provide resources to the field to further the investigation of this area.

show abstract

Use and safety of disease‐modifying therapy in pregnant women with multiple sclerosis

Cited by 16 publications

References 20 publications

A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 ConcePTION project

A systematic review and meta-analyses of pregnancy and fetal outcomes in women with multiple sclerosis: a contribution from the IMI2 ConcePTION project

Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy

The Intersection of Disability and Pregnancy: Risks for Maternal Morbidity and Mortality

Contact Info

Product

Resources

About