None of the disease-modifying therapies
are approved for use during pregnancy
or breastfeeding. The reviews by Coyle (2016)
, Bove et al. (2014)
and Cree (2013)
provide comprehensive information for clinicians who are counseling their patients about treatment options.
Women are advised to stop DMT for the appropriate period of time specific to that agent (Kaisey et al., 2018
). Because of its relative safety, some practitioners permit use of glatiramer acetate up until the time of conception. Women of child-bearing potential who wish to take teriflunomide
must be using effective birth control due to its teratogenic effects. Women on teriflunomide
who wish to become pregnant, and men on teriflunomide who wish to father a child, must stop the medication, undergo the recommended procedure for eliminating the drug from the body as quickly as possible, and wait until a confirmed level of < 0.02 mg/L has been achieved. Without accelerated elimination, the drug can persist for up to two years (teriflunomide prescribing information
Recent studies have reported that stopping natalizumab and/or fingolimod prior to pregnancy is associated with increased risk of relapse during pregnancy, but this observation may be confounded by the possibility that women with more active disease, who are at increased risk for relapse anyway, would be more likely to use these particular medications (Alroughani, et al., 2018
). Also stopping these agents has been reported to produce “rebound” disease activity ( Das et al., 2018
) which may also be contributing to the increased relapses seen during pregnancy after stopping natalizumab or fingolimod. In contrast, rituximab used within 6 months of conception may confer protection during pregnancy and has not been associated with increased relapses during pregnancy or major safety signal (Das et al., 2018
If a woman’s disease has been particularly active prior to and during pregnancy, the recommendation may be for her to resume her medication as soon as possible (within several weeks after delivery).
The impact of a father’s disease-modifying therapy regimen on spermatogenesis or fetal development has received less study. Data from several population-based clinical and health administrative databases in British Columbia, Canada found no association between paternal MS, disease duration at conception and level of disability with birth outcomes (Lu E et al., 2014)