/ by Jay Avasarala, MD, PhD
If you have multiple sclerosis (MS) and are ready to start a family, you may be concerned how your condition will affect your pregnancy – and vice versa. The good news is that there are a dazzling array of disease-modifying drugs (DMDs) as potential choice(s) for controlling your disease. It has also been long-recognized that pregnancy is protective against relapses in MS, with 70% reduction in relapse rates in the third trimester. The reduction in relapse rates during the last trimester rivals the "best" DMDs currently available on the market.
The post-partum period, however, is associated with an increased risk of relapses. You should also know that while the effect of breastfeeding in MS is probably protective, data are mixed.
Here are the facts about how your multiple sclerosis can be treated during pregnancy and afterwards:
Are any drugs approved for use in MS during pregnancy?
There are no prospective studies or clear guidelines on the use of DMDs during pregnancy and lactation. However, there is some evidence from ongoing pregnancy registries that certain DMDs are relatively safer for the developing fetus. No DMD has a category of A, which is the highest FDA designation for safety. Based on data from pregnancy registries, the closest to a safe drug during pregnancy is Copaxone.
Should I still breastfeed?
Because the data on this subject are mixed, it's best to have a discussion with your physician about breastfeeding. The FDA has generally recommended discontinuing DMDs while breastfeeding, but this is a precautionary approach and not based on scientific evidence.
What UK HealthCare can offer you
With the availability of MS fellowship-trained physicians, we are able to counsel you and provide you with DMD choices based on "best practices" and evidence that is current and up-to-date. We also have Dr. Amy Hessler in our ranks, who is a neurologist focused on women’s issues and neurology and is available for counseling.