Family planning considerations in people with multiple sclerosis

Kristen M Krysko, Ruth Dobson, Raed Alroughani, Maria Pia Amato, Riley Bove, Andrea I Ciplea, Yara Fragoso, Maria Houtchens, Vilija G Jokubaitis, Melinda Magyari, Azza Abdelnasser, Vasantha Padma, Sandra Thiel, Mar Tintore, Sandra Vukusic, Kerstin Hellwig*

*Corresponding author af dette arbejde

Abstract

Multiple sclerosis is often diagnosed in patients who are planning on having children. Although multiple sclerosis does not negatively influence most pregnancy outcomes, less is known regarding the effects of fetal exposure to novel disease-modifying therapies (DMTs). The withdrawal of some DMTs during pregnancy can modify the natural history of multiple sclerosis, resulting in a substantial risk of pregnancy-related relapse and disability. Drug labels are typically restrictive and favour fetal safety over maternal safety. Emerging data reporting outcomes in neonates exposed to DMTs in utero and through breastfeeding will allow for more careful and individualised treatment decisions. This emerging research is particularly important to guide decision making in women with high disease activity or who are treated with DMTs associated with risk of discontinuation rebound. As increasing data are generated in this field, periodic updates will be required to provide the most up to date guidance on how best to achieve multiple sclerosis stability during pregnancy and post partum, balanced with fetal and newborn safety.

OriginalsprogEngelsk
TidsskriftThe Lancet Neurology
Vol/bind22
Udgave nummer4
Sider (fra-til)350-366
Antal sider17
ISSN1474-4422
DOI
StatusUdgivet - apr. 2023

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