Skip To Main Content

Pregnancy and Lactation in MS

Learn about pregnancy and lactation in patients with multiple sclerosis (MS).

SECTIONS ON THIS PAGE

Women With MS
Importance of Counseling
Pregnancy and Relapse Rates
Considerations for Managing MS
Breastfeeding
Coordinating Care
Addressing Disparities
Abbreviations

Women With MS

Consider Family Planning Discussions Proactively in All Women of Childbearing Age With MS

3x women icon

Women are 3 times more likely than men to have MS1-4

~30 years calendar icon

With peak onset at ~30 years of age, MS mostly affects women of childbearing age2

1 in 3 women icon

1/3 of women with MS will have children after their diagnosis2,4

Women With MS Who Plan to Conceive Report Numerous Disease-related Concerns1

35% (N=116/332) of participants with MS surveyed felt that MS significantly impacted their decision to have children.1

Concerns among patients surveyed:

  1. Bonavita S, et al. Front Neurol. 2021;12:620772.
  2. Bove RM, et al. Continuum (Minneap Minn). 2022;28(1):12-33.
  3. Krysko KM, et al. Lancet Neurol. 2023;22(4):350-366.
  4. Mendibe Bilbao M, et al. Neurologia (Engl Ed). 2019;34(4):259-269.

Importance of Counseling

Proper Counseling May Address Some Women's Concerns Around Family Planning

Fetus with umbilical cord icon

Female fertility does not seem to be directly affected by MS1,2

  • More studies are needed to assess the potential effects of MS on male fertility1
Syringe injecting cell icon

Women with MS can be supported to pursue assisted reproductive technology (ART) if they desire1

  • Recent studies have not shown an elevated risk of relapse after ART1,3,4
Man and woman with child icon

There is a low risk of inheriting MS1,5

  • Risk of MS in offspring lies between 2.0% and 3.5%, and up to 20.0% if both parents are affected1
Hand holding a heart icon

There does not appear to be an increased risk of miscarriage or other severe neonatal outcomes in women with MS1,2

  • Higher rates of elective caesarean section, induced delivery, and small gestational size have been reported1,2,6

Developing patient education materials translated into relevant languages can help support adequate understanding about the important considerations for family planning in patients with MS7

  1. Krysko KM, et al. Lancet Neurol. 2023;22(4):350-366.
  2. Gklinos P, et al. Pharmaceuticals (Basel). 2023;16(5):770.
  3. Bove R, et al. Mult Scler. 2020;26(11):1410-1419.
  4. Graham EL, et al. Neurol Neuroimmunol Neuroinflamm. 2023;10(3).
  5. Westerlind H, et al. Brain. 2014;137(Pt 3):770-778.
  6. Andersen JB, et al. Neurol Clin Pract. 2021;11(4):280-290.
  7. Fragkoudi A, et al. Patient Educ Couns. 2023;110:107673.

Pregnancy and Relapse Rates

  • Relapse rates decreased with each trimester during pregnancy3
  • The greatest risk of disease activity in the peri-pregnancy period occurs in the first 3 months postpartum.

Risk factors for postpartum relapses may include pre-pregnancy disease activity and severity4-6

  1. Gklinos P, et al. Pharmaceuticals. 2023;16(5);770.
  2. Tisovic K, et al. Biomedicines. 2019;7(2):32.
  3. Dobson R, et al. Mult Scler Relat Disord. 2020;44:102241.
  4. Krysko KM, et al. Lancet Neurol. 2023;22(4):350-366.
  5. Varytė G, et al. Medicina (Kaunas). 2020;56(2):49.
  6. Anderson A, et al. Neurol Neuroimmunol Neuroinflamm. 2021;8(2):e959.

Considerations for Managing MS

Considerations for the Management of MS Are Different for Each Woman’s Unique Situation1-5

Pre-pregnancy During Pregnancy Postpartum

Ideally, disease would be stable prior to attempting to conceive6,7,8

  • Recommendations for standard prenatal care should be followed6,7,8
 The decision to use DMTs, corticosteroids, and/or symptomatic therapy during pregnancy should include an evaluation of the mother’s risk of symptom exacerbation and the potential harm to the mother and fetus1,2,4-6,10

In addition to standard postpartum care, women with MS may need additional support

  • Physical therapy has demonstrated benefits for MS-related and postpartum symptoms10-12
  • Women with MS may be at higher risk of postpartum depression10,11,13

Corticosteroids have been used to manage relapses during pregnancy1,5,6

  • Early data suggested that exposure to glucocorticosteroids during the first trimester may be associated with an increased risk of teratogenic effects, but more recent data have failed to demonstrate an increased risk1,5,6,9

Management of Disease-modifying Therapies (DMTs) Includes Assessing Benefits and Risks to Both the Mother and Fetus

  • Treatment recommendations vary by medication, and product-specific prescribing information should be considered
  • General recommendations are to discontinue DMTs temporarily prior to conception1-2,4-6,14
  • Certain DMTs are associated with an increased risk of rebound upon cessation1-2,4,7,15
  • Recommended washout periods for DMTs should be considered to mitigate risk of fetal exposure, especially in the case of DMTs with teratogenic potential11,14,16
  1. Krysko KM, et al. Lancet Neurol. 2023;22(4):770.
  2. Gklinos P, et al. Pharmaceuticals. 2023;16(5);770.
  3. Langer-Gould AM. Continuum (Minneap Minn). 2019;25(3):773-792.
  4. Rae-Grant A, et al. Neurology. 2018;90(17):777-788.
  5. National MS Society. Pregnancy and Reproductive Issues. Accessed June 4, 2023. https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Pregnancy
  6. Mendibe Bilbao M, et al. Neurologia (Engl Ed). 2019;34(4):259-269.
  7. Tisovic K, et al. Biomedicines. 2019;7(2):32.
  8. Dobson R, et al. Pract Neurol. 2019;19(2):106-114.
  9. ACOG Committee Opinion No. 776. Obstet Gynecol. 2019;133(4):e287-e295.
  10. Iyer P, et al. Neurol Ther. 2023;12(1):1-10.
  11. Krysko KM, et al. Curr Treat Options Neurol. 2021;23(4):11.
  12. Block VJ, et al. Mult Scler Relat Disord. 2021;48:102703.
  13. Krysko KM, et al. Mult Scler. 2022;28(6):970-979.
  14. Villaverde-González R. Degener Neurol Neuromuscul Dis. 2022;12:1-21.
  15. Dobson R, et al. Pract Neurol. 2023;23(1):6-14.
  16. Coyle PK. Ther Adv Neurol Disord. 2016;9(3):198-210.

Breastfeeding

Women With MS Who Plan to Breastfeed Can Be Supported With Discussions About Treatment Benefits and Risks:

  • Breastfeeding can offer many health benefits to the mother and newborn1,2
  • The potential transfer of DMTs into breast milk, with resultant infant exposure, is a common concern1,2
    • Recent studies show that some classes of DMTs have low transfer into breast milk.1,2 Product-specific prescribing information should be considered
  • In a meta-analysis (15 studies; N=1804) during the postpartum period, those who breastfed had a 37% decreased risk of postpartum relapse (OR, 0.63, 95% CI, 0.45-0.88)3a

Footnote

  1. Risk reduction was even greater (OR, 0.52, 95% CI, 0.28-0.97) in those who exclusively breastfed for 2 months.3

References

  1. Dobson R, et al. Curr Opin Neurol. 2021;34(3):303-311.
  2. Krysko KM, et al. Curr Treat Options Neurol. 2021;23(4):11.
  3. Krysko KM, et al. JAMA Neurol. 2020;77(3):327-338.

Coordinating Care

Collaboration and Good Communication Between Providers Is Key to Delivering Quality Care

Coordinating care among clinicians allows for alignment on treatment decisions affecting the mother and infant1,2

  1. Krysko KM, et al. Curr Treat Options Neurol. 2021;23(4):11.
  2. Dobson R, et al. Pract Neurol. 2019;19(2):106-114.

Addressing Disparities

Disparities in Access to Care Can Have an Impact on Pregnancy Outcomes

A recent study evaluated racial disparities in care between pregnant Black (n=81) and Hispanic women (n=67) and White women with MS (n=146).1a

At baseline -
these Black and Hispanic women:
  • Lived in areas with lower Child Opportunity Indexb
  • Were less employed
  • Were less privately insured
  • Had higher disability (EDSS)
Disparities in care and worse clinical outcomes were observed:
  • Increased disability (EDSS)
  • Higher relapse rate (ARR)
  • Fewer recommended prenatal screenings
  • Decreased lactation support

Footnotes

  1. Multicenter cohort study in 294 patients with MS.
  2. The Child Opportunity Index measures the quality of available resources by neighborhood and conditions important to healthy childhood development.2

References

  1. Radzik AM, et al. Race disparities in pregnancy care and clinical outcomes in women with MS: a diverse, multicenter cohort. Abstract presented at: American Academy of Neurology Annual Meeting; April 22-27, 2023; Boston, MA. S31.002.
  2. DiversityDataKids.org. Accessed August 11, 2023. http://new.diversitydatakids.org/research-library/research-brief/what-child-opportunity?_ga=2.66992045.2090869039.1691769513-152753725.1691769513

Looking for more information?

Reach out to a Genentech Medical Science Liaison near you, or connect with the contact center.

Connect with an MSL
Submit a Request

Call Us: 1-800-821-8590 Hours: Monday-Friday, 5am-5pm PT

TOP

  • AAAAI
    American Academy of Allergy Asthma & Immunology

  • AE
    Adverse event

  • Ang2
    Angiopoietin-2

  • ARR
    Annualized Relapse Rate

  • ART
    Assisted Reproductive Technology

  • ASTCT
    American Society for Transplantation and Cellular Therapy

  • ATG
    Anti-thymocyte globulin

  • CAR
    Chimeric antigen receptor

  • CD3
    Cluster of differentiation 3

  • CD4
    Cluster of differentiation 4

  • CD8
    Cluster of differentiation 8

  • CD19
    Cluster of differentiation 19

  • CD20
    Cluster of differentiation 20

  • CD226
    Cluster of differentiation 226

  • CDC
    Centers for Disease Control and Prevention

  • CI
    Confidence Interval

  • COVID-19
    Coronavirus disease of 2019

  • CPAP
    Continuous positive airway pressure

  • CR
    Complete response

  • CRP
    C-reactive protein

  • CRS
    Cytokine release syndrome

  • CT
    Computed tomography

  • CTCAE
    Common Terminology Criteria for Adverse Events

  • DIC
    Disseminated intravascular coagulation

  • DLBCL
    Diffuse large B-cell lymphoma

  • DMT
    Disease-modifying therapy

  • DMT
    Disease-modifying treatment

  • DoCR
    Duration of complete response

  • DoR
    Duration of response

  • DBPCFC
    Double-blind, placebo-controlled food challenge

  • ECOG PS
    Eastern Cooperative Oncology Group performance status

  • ECTRIMS
    European Committee for Treatment and Research in Multiple Sclerosis

  • EDSS
    Expanded Disability Status Scale

  • EMA
    European Medicines Association

  • FAERS
    FDA Adverse Event Reporting System

  • FDA
    Food and Drug Administration

  • FDA
    US Food and Drug Administration

  • FL
    Follicular lymphoma

  • HCP
    Health Care Provider

  • HGBCL
    High-grade B-cell lymphoma

  • HLH
    Hemophagocytic lymphohistiocytosis

  • ICANS
    Immune effector cell-associated neurotoxicity syndrome

  • ICU
    Intensive care unit

  • Ig
    Immunoglobulin

  • IgE
    Immunoglobulin E

  • IgG1
    Immunoglobulin G1

  • INR
    International normalized ratio

  • IRC
    Independent Review Committee

  • IRR
    Infusion-related reaction

  • ITIM
    Immunoreceptor tyrosine-based inhibitory motif

  • LLN
    Lower limit of normal

  • LMP
    last menstrual cycle

  • LMP
    Last menstrual period

  • MAS
    Macrophage activation syndrome

  • MCA
    Major congenital anomalies

  • MHC
    Major histocompatibility complex

  • MS
    Multiple sclerosis

  • MSKCC
    Memorial Sloan Kettering Cancer Center

  • NK
    Natural killer

  • NO
    Nitric oxide

  • NOS
    Not otherwise specified

  • OB/Gyn
    Obstetrics and Gynecology

  • OCR
    OCREVUS (ocrelizumab)

  • OR
    Odds ratio

  • ORR
    Objective response rate

  • PD-1
    Programmed cell death protein 1

  • PD-L1
    Programmed death-ligand 1

  • PET
    Positron emission tomography

  • PFS
    Progression-free survival

  • PMBCL
    Primary mediastinal B-cell lymphoma

  • PML
    progressive multifocal leukoencephalopathy

  • PPMS
    Primary progressive multiple sclerosis

  • PTT
    Partial thromboplastin time

  • PVR
    Poliovirus receptor

  • RID
    Relative infant dose

  • RMS
    Relapsing multiple sclerosis

  • RRMS
    Relapsing-remitting multiple sclerosis

  • SAE
    Serious adverse event

  • T
    Trimester

  • TCR
    T-cell receptor

  • TIGIT
    T cell immunoreceptor with Ig and ITIM domains

  • UCSF
    University of California San Francisco

  • USPI
    United States Prescribing Information

  • URTI
    Upper respiratory tract infection

  • UTI
    Urinary tract infection

  • VWF
    von Wilebrand factor

  • NIH
    National Institutes of Health