The challenge of pregnancy in women with multiple sclerosis.

About 50 years ago, women with multiple sclerosis were advised to avoid becoming pregnant. Evidence from epidemiological research has since shown that pregnancies do not impact the disease course 1 Gavoille A Rollot F Casey R et al. Investigating the long-term effect of pregnancy on the course of multiple sclerosis using causal inference. Neurology. 2022; (published online Dec 23.)https://doi.org/10.1212/WNL.0000000000206774 Google Scholar and that the development of children is not negatively affected by having a mother with multiple sclerosis. 2 Haker M Peper J Haagen M Heesen C Rahn AC The psychosocial impact of parental multiple sclerosis on children and adolescents: a systematic review. Int J MS Care. 2022; (published online Oct 13.)https://doi.org/10.7224/1537-2073.2021-075 PubMed Google Scholar The risk of inheriting the disease is also low, 3 Krysko KM Dobson R Alroughani R et al. Family planning considerations in people with multiple sclerosis. Lancet Neurol. 2023; 22: 350-366 Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar providing further reassurance to families affected by multiple sclerosis who wish to have children. Nonetheless, there are many uncertainties to consider for women with multiple sclerosis; for example, that future acute relapses and disability might affect their ability to care for their children. Although immunotherapies for multiple sclerosis are constantly evolving, as is medical knowledge on fertility and pregnancy, management guidelines in this area should be regularly revised and updated. Family planning considerations in people with multiple sclerosisMultiple sclerosis is often diagnosed in patients who are planning on having children. Although multiple sclerosis does not negatively influence most pregnancy outcomes, less is known regarding the effects of fetal exposure to novel disease-modifying therapies (DMTs). The withdrawal of some DMTs during pregnancy can modify the natural history of multiple sclerosis, resulting in a substantial risk of pregnancy-related relapse and disability. Drug labels are typically restrictive and favour fetal safety over maternal safety. Full-Text PDF