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Multiple Sclerosis Treatment during Pregnancy

Disease Modifying, Acute Relapse and Symptomatic Treatment of Multiple Sclerosis During Pregnancy and Lactation – MRI and MRI Contrast During Pregnancy

Multiple Sclerosis Treatment during Pregnancy

Apart from sexual dysfunction, MS does not adversely affect fertility and pregnancy outcome, such as birth defects or miscarriages.
Hormonal contraceptives have no known effects on multiple sclerosis course and prognosis. Hormonal preparation prior to in vitro fertilization might be associated with temporarily increase in MS relapse rate.

Pregnancy and breastfeeding have positive effects on the relapse rate and probably long term disability outcome.

Profound body changes during pregnancy have multiple effects on the immune system. Fetus is a foreign body from the immune system prospective. In order to avoid immune attack against the baby, the immune system goes through significant transformation. Elevated hormones levels suppress inflammation responses. Immune system cells become more tolerant to unfamiliar substances. There is some evidence that pregnancy facilitates nervous system recovery mechanisms after relapses. These are the reasons for the decreased disease activity during pregnancy.

First attacks of MS only rarely start during pregnancy. For the same reasons MS flare ups are common after the delivery. Those patients who relapse during pregnancy are at increased risk of relapse after the delivery.

Due to concerns about drug effects on the baby, there is tendency to refrain from disease modifying treatment during pregnancy. Very few drugs used in multiple sclerosis management are considered safe during pregnancy.

There are no strict guide lines about proper MS management during pregnancy. Most of the treatments have to be stopped prior to conception.

Treatment during pregnancy is reserved only for patients with very active disease.

Relapse Prevention During Pregnancy in Multiple Sclerosis

Interferon Beta during Pregnancy and Lactation
(Avonex, Betaseron, Rebif)

There is no proof that normal therapeutic interferon beta doses can cause birth defects in humans. Interferons probably do not cross placenta, so the drug cannot affect the baby.
In animal studies higher then therapeutic doses of interferon beta are proven to cause miscarriages. In humans, however, this complication has not been reported.
The only proven effect on human fetus, so far, is lower than average birth weight and length together with higher rate of prematurity.
A reasonable recommendation is a discontinuation of the drug (if disease course allows) about a month prior to intended conception. Interferon beta gets into the breast milk in negligible amounts, so it is considered safe during breastfeeding.

Glatiramer Acetate during Pregnancy and Lactation

If any relapse prevention treatment is needed during pregnancy, Glatiramer Acetate is the best choice. No pregnancy or breastfeeding related issues have been reported due date.
Due to the large molecule size it probably does not cross placenta. No adverse effects on the offspring were observed in animal studies at much higher doses.
Glatiramer Acetate earned pregnancy category B by FDA (same as Tylenol).

   The rest of disease modifying medications have to be avoided during pregnancy, because all of them are known to cause either birth defects or miscarriages at least in animals. The only question is; how long in advance of the planned pregnancy they have to be stopped.

Fingolimod during Pregnancy and Lactation

Fingolimod causes multiple birth defects and fetal death in animals. In humans it causes birth defects, spontaneous abortion and ectopic pregnancy. Fingolimod crosses placenta and gets into breast milk.
It takes about 2 months to clear it from the body; so it must be stopped 2 months prior to conception.

Dimethyl Fumarate (BG-12) during Pregnancy and Lactation

Birth defects are known in animals. Human studies on exposure to Dimethyl Fumarate during pregnancy are ongoing. No information is available on breast milk concentration.
A reasonable time for discontinuation is about a month prior to conception.

Natalizumab during Pregnancy and Lactation

In animal studies, higher than therapeutic doses produce decreased pup survival and blood disorders. Early pregnancy exposure in humans has not been associated with birth defects or premature births so far.
Treatment during pregnancy produces temporarily blood problems in the newborn. Natalizumab does cross placenta and gets into breast milk in small amounts.
Natalizumab clears from the body within 3 months. If needed, a few plasma exchange treatments can remove it from the body much faster.

Teriflunomide during Pregnancy and Lactation

Teriflunomide is one of the worst drugs during pregnancy. Even though, no adverse effects on the fetus are known in humans, animal studies are very discouraging. A wide range of birth defects and fetal deaths have been observed in multiple species.

This drug might persist in the body for to up to 2 years. Treatments for rapid removal of the drug from the system are available.
Considering excretion of the drug with the semen, the male partner has to be cleared from the drug prior to conception.

Acute MS Relapse Treatment during Pregnancy

High dose steroids for 3 to 7 days is a current relapse treatment approach. During the second and the third trimesters this treatment is probably relatively safe.

Steroid treatment during the first trimester may cause cleft palate and low birth weight. It is reasonable to avoid treatment with betamethasone and dexamethasone, because these steroids cross placenta unaltered.

Prednisone, prednisolone, and methylprednisolone are metabolized by placenta, therefore limiting fetal exposure to steroids.

Symptomatic MS Treatment during Pregnancy

Symptomatic treatment is to be avoided during pregnancy altogether. There are multiple groups of drugs used for symptomatic management of MS produced secondary symptoms.
Since symptomatic treatment does not affect the disease prognosis and long term disability, only absolutely necessary drugs could be continued during pregnancy (providing they are safe).

MRI and MRI Contrast during Pregnancy

Negative effects of MRI during pregnancy were never documented. Nevertheless, MRI is recommended to be avoided during the first trimester and is to be used only if absolutely necessary in the rest of the term.
Gadolinium (MRI contrast) enters the fetal circulation and is contraindicated during pregnancy. It is acceptable only in exceptional cases.

Important!

This article is intended for educational purpose only. You should not use this information as guide for self-treatment. Please, consult your doctor on every single medication you are planning to take during pregnancy.

 

Any comments about this page will be greatly appreciated at doctorstrizhak@gmail.com Content copyright 2017. DOCTORSTRIZHAK.COM. All rights reserved.
Disclosure: This Web Site is intended for education purpose only. The information provided on this site must not be perceived as a guide for self-diagnosis or self-treatment. Every effort is made to keep the information current, but there are absolutely no guarantees of timely updates. By Andre Strizhak