The current thinking on pregnancy and multiple sclerosis.
Multiple sclerosis (MS) affects approximately 3 times as many women as men, with the highest prevalence observed in women of reproductive age.1 Counseling these patients about pregnancy-related concerns can be challenging due to the lack of consensus guidelines and the increase in MS treatment options in recent years.
While it is now well-established that having MS should not limit patients’ reproductive choices, this was not always the case. “At one time it was believed that having multiple pregnancies — or even one — could harm patients with MS, but this has not been found to be accurate,” Mary R. Rensel, MD, ABIHM, staff neurologist and director of wellness and pediatric programming at Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research in Ohio, told Neurology Advisor.
Several reviews have comprehensively addressed this topic, including one published in April 2018 in Neurology: Clinical Practice, which aimed to provide guidance to general neurologists regarding the specific needs of this population.2 Evidence-based considerations relevant to each stage are highlighted below.
- MS does not appear to affect fertility or rates of spontaneous abortion, stillbirth, premature birth, Cesarean delivery, or birth defects.1 Patients can also be assured that MS is not an inherited disease, although the risk for developing MS is slightly higher in individuals who have a first-degree relative with MS vs individuals who do not (0.13% vs 2% to 2.5%).1
- In addition to basic counseling regarding the need for prenatal vitamins, adequate sleep and nutritional intake, and avoidance of alcohol and smoking, women with MS who are planning a pregnancy should be assessed for vitamin D deficiency and treated if indicated. A 2015 study found that women with MS had lower vitamin D levels during pregnancy and in the postpartum period.3
- Women should be counseled on contraceptive options prior to initiating disease-modifying therapy (DMT) as DMTs are generally considered not safe for use during pregnancy. Long-acting reversible contraceptive methods appear to have the highest efficacy and safety.4
“The main pre-pregnancy considerations for women with MS concern[s] starting and stopping medications — DMTs must be stopped for an appropriate period of time prior to a planned conception,” Barbara S. Giesser, MD, professor of neurology at the University of California, Los Angeles (UCLA), and clinical director of the MS program at UCLA, said in an interview with Neurology Advisor. “This is also true for most medications used for management of symptoms such as spasticity, pain, and bladder dysfunction.” She added that glatiramer acetate is an exception, which some neurologists allow their patients to use until pregnancy is confirmed.2
|Read on: Reproductive Management in Multiple Sclerosis: Quick Takeaways for Your Practice|