MS and Pregnancy: Addressing Misperceptions About Anti-CD20 Therapies and Childbearing

In this episode titled "MS and Pregnancy: Addressing Misperceptions About Anti-CD20 Therapies and Childbearing," the panel addresses common patient misperceptions about anti-CD20 therapies. Dr. Williams begins with a topic Dr. Bove is particularly well-positioned to address: the misperception that B-cell depleting therapies are unsafe or incompatible with pregnancy.

Dr. Bove summarizes the current evidence reassuringly. When anti-CD20 therapy is discontinued in the months prior to conception, data show no elevated fetal risk: there is negligible placental transfer, babies are born with normal B-cell counts and vaccine responses, and maternal disease is well protected during the preconception, pregnancy, and postpartum periods. Trace amounts of anti-CD20 agents enter breast milk but are not meaningfully absorbed by the infant — and breastfed babies show normal immune development.

For patients who received an infusion and later discover they were in their first trimester, Dr. Bove advises against panic: data show that even with early-pregnancy exposure, most babies are born with normal B-cells and without adverse outcomes such as pregnancy loss or malformations. The recommended response is engagement with a high-risk OB and CBC/B-cell testing of cord blood or the newborn at delivery.

Dr. Williams reinforces that family planning conversations should begin at the very first clinical encounter — not as an afterthought — to ensure that treatment strategy can be woven around reproductive goals from the outset.

In the next episode, "Common Misperceptions About Anti-CD20 MS Therapy: Immunosuppression, Drug Differences, and Peer Support," panelists each address a key patient misconception about the class and discuss the role of patient-to-patient mentorship in therapy acceptance.