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Disease Management Before, During and After


None of the disease-modifying therapies are approved for use during pregnancy or breastfeeding. The overview by Cree (2013) provides comprehensive information for clinicians who are counseling their patients about treatment options.

Women are generally advised to stop their medication one to two menstrual cycles prior to trying to conceive (Ferrero et al., 2004). Women of child-bearing potential who wish to take teriflunomide (pregnancy rating X) or mitoxantrone (pregnancy rating D) must be using effective birth control. 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. Women and men of child-bearing potential who wish to take mitoxantrone  (pregnancy rating D) must be using effective birth control and may wish to harvest and store eggs/sperm for future use.

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 approximately two weeks after delivery). Intravenous immunoglobulin (IVIG) administered during  the post-partum period may reduce the risk of relapse (Achiron et al., 2004).

The impact of a father’s disease-modifying therapy regimen on spermatogenesis or fetal development has received little study.  A man may want to consider stopping his injectable medication, fingolimod, or natalizumab during efforts to conceive.