Pregnancy

The risk of MS relapse is decreased in pregnancy, but this is balanced by an increased risk of relapse in the first 3 months after delivery. Pregnancy does not alter the prognosis of MS. Ideally, pregnancies should be planned with expert advice from a neurologist and an obstetrician.

Disease activity during pregnancy is sufficiently infrequent that in most cases immunotherapy can be stopped before attempting conception. However, if treatment is withdrawn too early, relapses may develop. When (or whether) to stop therapy is an expert decision that is different for each patient, and based on several factors (eg teratogenicity of the drugs, potential for rebound disease activity, severity of MS). Teriflunomide has a long half-life and is category X¹ —before the patient attempts conception, the drug needs to be washed out with charcoal or colestyramine. Fingolimod is category D², so therapy must be stopped before the patient attempts conception.

Disease activity can be treated with corticosteroids during pregnancy, but seek expert advice if this is not sufficient and ongoing treatment is required.

Pregnancy and labour are managed as for females without MS (ie with the usual procedures [including epidural anaesthesia, if indicated] and drugs).

¹ The Australian Therapeutic Goods Administration Prescribing medicines in pregnancy database defines category X as ‘Drugs which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy’.Return

² The Australian Therapeutic Goods Administration Prescribing medicines in pregnancy database defines category D as ‘Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details’.Return