Treating Women of childbearing age with MS

MS and fertility

For the first of his two presentations on pregnancy in MS, Prof. Centonze considered issues around pre-pregnancy. His first case study involved a 29-year-old woman looking to start a family, but worried about how MS may affect her fertility. This reflects the reality of many patients of child-bearing age who have many concerns around what pregnancy may mean for their disease progression as well as the risk to the unborn child.

It is important to discuss the genetic risk of a child being born with MS, but it should be emphasised that the risk is very low. Patients should also be counselled about environmental factors, such as smoking and vitamin D levels when considering starting or growing a family. Of course, contraception choice is also an important consideration for women of child-bearing age. Conversely, many patients ask about assisted fertility and whether hormone-based approaches to fertility could affect the disease course or their response to DMTs.

DMTs and pregnancy

It is always difficult to decide the right time to discontinue DMT if a patient wishes to become pregnant. Indeed, it is now understood that some DMTs may not need to be discontinued before or during pregnancy. Five years ago, patients seeking to get pregnant were recommended to discontinue any treatment. This approach may have a negative impact on prevention of disease progression. For established treatments the currently accepted approach is to continue treatment until pregnancy is confirmed. For some DMTs, there is a concern that interruption of treatment could lead to rebound, especially where these drugs are stopped abruptly. It may be better to continue drugs for a specified period and then slowly start to taper them in order to avoid rebound. Overall, it seems that pregnancy may be protective against disease, however, further long-term studies are needed.

The case study finished with the patient delivering a healthy baby girl after two miscarriages.