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Multiple Sclerosis International
Volume 2016 (2016), Article ID 1034912, 8 pages
http://dx.doi.org/10.1155/2016/1034912
Review Article

Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks

1Division of Neurology, Amiri Hospital and Division of Neurology, Dasman Diabetes Institute, Dasman, Kuwait
2Division of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
3King Abdullah International Medical Research Center, King Saud Ben Abdulaziz University for Health Sciences, NGHA, Riyadh, Saudi Arabia
4KFMC, Ministry of Health, Riyadh, Saudi Arabia
5MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
6Clinical Neurosciences Department, Salmaniya Medical Complex, Manama, Bahrain
7Neurology Section, King Khalid University Hospital, King Saud University and Dallah Hospital, Riyadh, Saudi Arabia
8King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
9Department of Internal Medicine, Neurology Section, Arab Medical Center and Khalidi Hospital, Amman, Jordan
10Department of Neurology (Medicine), Hamad Medical Corporation, Doha, Qatar
11Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario, Málaga, Spain
12Laboratory of Experimental Neurology and Neuroimmunology, Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
13Neurology Department, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, UAE
14Department of Neurology, Neuroimmunology Unit, Hacettepe University Hospitals, Ankara, Turkey
15Merck, Intercontinental Region, Dubai, UAE
16Department of Neurology, 1st St. Petersburg State Medical University n.a. I.P. Pavlov, St. Petersburg, Russia
17Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
18Faculty of Medicine, Ain Shams University, Cairo, Egypt
19Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Received 5 August 2016; Accepted 14 November 2016

Academic Editor: Mauro Zaffaroni

Copyright © 2016 Raed Alroughani et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The burden of multiple sclerosis (MS) in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs), which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation.