Managing Postpartum MS: Safety Data, Relapse Risk, and Real-World Practice

Episode 1 of the MS Compass: Guiding Clinical Care^® podcast is now live! Scroll down to listen or click here to subscribe on your favorite streaming service.

MS Compass: Guiding Clinical Care is a NeurologyLive podcast led by Lindsay Ross, MD, a board-certified neurologist specializing in multiple sclerosis and neuroimmunology at the Cleveland Clinic’s Mellen Center. The series centers on the unique clinical considerations facing women with MS, from emerging research and evolving treatment strategies to gaps in care that are gaining renewed attention. Through conversations with expert guests across neurology and related disciplines, Ross examines how science, advocacy, and real-world practice are shaping the next era of MS care for women.

In this initial episode, host Lindsay Ross, MD, is joined by Edith Graham, MD, assistant professor of neurology at Northwestern University Feinberg School of Medicine, for an in-depth discussion on managing multiple sclerosis during breastfeeding. The conversation examines how postpartum care decisions are evolving as more safety, pharmacokinetic, and infant outcome data become available, particularly around the use of disease-modifying therapies during lactation. Furthermore, Ross and Graham discuss the growing comfort with anti-CD20 monoclonal antibodies, how relapse risk and breastfeeding physiology factor into treatment timing, and the practical considerations clinicians weigh when counseling patients during this critical phase of MS care.

EPISODE BREAKDOWN

• 0:50 – How frequently clinicians continue disease-modifying therapy during breastfeeding
• 2:15 – Shifting from interferons to monoclonal antibodies in postpartum MS care
• 3:30 – Lactation physiology and what it means for monoclonal antibody transfer into breast milk
• 5:50 – Safety data for anti-CD20 therapies including ocrelizumab, ofatumumab, and rituximab
• 8:15 – Practical differences across anti-CD20 agents and how they influence treatment selection
• 13:50 – Adjusting infusion premedications to reduce infant exposure during breastfeeding
• 16:50 – The unique challenges of natalizumab use during the postpartum period
• 20:10 – Weaning physiology, premature infants, and remaining gaps in breastfeeding safety data
• 24:30 – Balancing breastfeeding-related relapse protection against postpartum relapse risk
• 26:55 – Why many clinicians are moving toward a “why not treat” mindset during breastfeeding
• 28:40 – Recent relapses drive postpartum DMT restart decisions
• 29:30 – Postpartum prophylactic steroids discouraged; COP-MS shows none
• 31:15 – Anti-CD20 postpartum outcomes still lack robust data
• 33:40 – LactMed-guided symptom meds: gabapentin, baclofen, Botox, PT

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References Mentioned Throughout the Episode
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