Treating MS in pregnancy

• MS is a disease that predominantly affects young women and is often diagnosed at a time when many women are considering having children.
• Traditionally women have not taken treatment during pregnancy but given the possibility of disability accumulation when off treatment, there is great interest in whether treatments can be given in pregnancy.

• A large international study has looked at over 1500 pregnancies that had a short overlap with MS medications being taken by the women. It found that there was no difference in the rates of full-term pregnancies, pre-term or premature deliveries or miscarriages.

• The Association of British Neurologists has released consensus guidelines for the treatment of MS in pregnancy, based on data taken from pregnancy registers of MS medications and other sources.

MS affects at least twice as many more women than men, and it often strikes at an age when many people are thinking about starting or growing their families.

People with MS have the same chance of having children as those without MS. It does however mean that treatment options for women with MS during pregnancy can be problematic.

The safety of MS treatment during pregnancy

While there has been a recent push for earlier treatment in those affected by MS to prevent the accumulation of disability in the long term, traditionally women have been advised to stop treatment in the lead up to or during pregnancy, potentially risking damaging relapses. There has also not been much research about the safety of disease modifying therapies during pregnancy in MS, meaning that people with MS and their medical teams are making decisions with limited information.

Two recent publications aim to redress this balance by providing evidence and guidelines for the use of disease modifying treatments while pregnant.

The first is a large international study, led by Australian researcher Dr Vilija Jokubaitis from Monash University. It uses data from the large clinical database MSBase, which captures information about treatments and outcomes from thousands of people with MS world-wide.

Published in Multiple Sclerosis and Related Disorders, the analysis includes data from over 9,000 women with MS between the ages of 15 and 45. In this group, 1,178 women recorded 1,521 pregnancies. 42% of these pregnancies occurred while the woman was taking a disease modifying therapy for their MS. These pregnancies were compared to the 20% that occurred within a year of stopping treatment, and the 39% where the woman had received no treatment for over a year. On average, women were on treatment for 30 days of their pregnancy, regardless of the type of therapy used.

When they compared pregnancy outcomes in people on treatment to those off treatment, there was no difference in the rates of full-term pregnancies, pre-term or premature deliveries or miscarriages. Women were more likely to have had an induced abortion if they were on MS treatments that carry the higher pregnancy classifications (either evidence of some harm to the foetus in pregnant women or evidence of harm from animal studies).

Guidelines about MS treatments in pregnancy

In addition, the Association of British Neurologists have released consensus guidelines for the treatment of MS in pregnancy. The guidelines were based on data from pregnancy registers that are maintained for some of the MS medications currently available and other published information.

The guidelines provide very detailed recommendations for clinicians about the use of each of the currently available medications during pregnancy, as well as identifying these key points for women with MS who wish to have children:

• Treatment for MS should not be delayed until a woman has completed her family and that doctors should keep in mind the possibility of pregnancy when prescribing treatment to all women with MS of childbearing age.

• Relapse rates naturally fall during pregnancy, and so many women with MS choose to stop MS medications once they are pregnant, however, first line injectable treatments (interferon betas and glatiramer acetate) can be continued throughout pregnancy. It is recommended that other types of treatments are stopped where possible.

• For women with very active MS, treatment throughout pregnancy should be considered.

• Corticosteroids, a standard treatment for relapse, can be given during pregnancy and while breastfeeding to women who experience relapses.

• Women with MS are no more likely to have high risk pregnancies than other women, and unless there are other reasons, having MS should not limit the birthing options or management of delivery.

Both studies highlighted the need for further ongoing tracking of medications and pregnancies in women with MS and the need for greater data collection to inform this important topic.

Given the variability of MS and the need to consider personal life circumstances and other health factors in making choices about MS treatments, it is important for women with MS who are considering or planning pregnancies to discuss their treatment options with their medical team.

With thanks to MS Research Australia – the lead provider of research summaries on our website.