Abstract
Background
In Multiple Sclerosis (MS) women, therapeutic management for pregnancy planning and
during pregnancy still represents a challenge regarding timing of disease-modifying
therapies (DMT) stop, risk of disease reactivation and potential fetal toxicity. The
objective of this study was to describe disease activity during pregnancy and postpartum
depending on treatment status before conception in women with MS.
Methods
339 MS patients who have achieved a pregnancy between 2007 and 2017 were included.
Women were classified according to their exposure to DMT in the 18 months period prior
to pregnancy (untreated / first- / second/third-line treatment).
Results
122 women were not exposed to DMT prior to conception, whereas 147 were exposed to
first-line DMT and 70 to second/third line DMT (73% to natalizumab and 23% to fingolimod)
before conception. In the first-line group, the ARR decreased from 0.39 during the
year before conception to 0.21 during pregnancy, whereas it increased in the second/third-line
group from 0.59 to 0.78. 47.1% of the second/third-line group faced at least one relapse
during pregnancy and the time from conception to first relapse was significantly shorter
in this group (p < 10−4). The risk of relapse during pregnancy and postpartum was associated with occurrence
of pre-conception relapses and second/third line DMT exposure before pregnancy.
Conclusion
Careful consideration should be given to natalizumab and fingolimod exposed patients
before conception as they are at higher risk of reactivation of MS during pregnancy.
Keywords
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Article info
Publication history
Published online: August 15, 2022
Accepted:
August 14,
2022
Received:
August 1,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
