Pregnancy and Lactation in Multiple Sclerosis

Opinion
Video

Ahmed Obeidat, MD, PhD, Riley Bove, MD, Stephen Krieger, MD, and Erin Longbrake, MD, PhD, review strategies for optimizing treatment of women with MS who are pregnant while minimizing risks. They also talk about evolving approaches to managing women who are breastfeeding.

This is a video synopsis/summary of a panel discussion involving Ahmed Obeidat, MD, PhD; Riley Bove, MD; Stephen Krieger, MD; and Erin Longbrake, MD, PhD.

Specializing in managing pregnancy and lactation in patients, the speaker emphases regularly discussing family planning with those of childbearing potential. Patients often do not volunteer this information, making it essential to ask at every visit due to changing plans and circumstances.

For those planning to conceive, avoiding disease-modifying therapies that could pose risks during pregnancy is stressed. Discontinuing treatments like S1P receptor modulators well in advance of planned conception is advised to minimize fetal exposure.

One strategy recommended is treating patients with B-cell depleting therapies before pregnancy. This approach ensures that by the time of conception, the drug is cleared from the system, minimizing risks to the baby. This planning helps alleviate the stress often associated with pregnancy planning for many patients.

The postpartum period is highlighted as a critical phase, with many patients experiencing clinical relapses or new lesions. Research on the transfer of medications into breast milk reveals reassuring findings on the minimal transfer of immunoglobulin G (IgG) monoclonals, making breastfeeding safer for treated patients.

Having multiple sclerosis (MS) should not deter patients from family planning goals. With the availability of highly effective treatments, including B-cell depleting therapies, patients can confidently plan for pregnancies with appropriate medical guidance.

The field has seen advancements, with pharmaceutical companies investing in understanding the safety of their products for pregnancy and breastfeeding. However, monitoring babies for longer-term outcomes remains necessary due to the complexity of immune biology and potential risks beyond simple medication transfer.

Overall, this work has empowered women with MS and their families, enabling them to make informed decisions about family planning while managing their condition effectively.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.

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