Delay pregnancy until MS is less active: study – ECTRIMS 2019

Highlights from the 35th congress of the European Committee for Treatment and Research in MS (ECTRIMS), September 11-13, 2019 – Doctors will often advise women with MS who are thinking of becoming pregnant to put off the decision until their MS is under control. A new study supports that advice – but for somewhat different reasons.

MS doesn’t affect fertility and there is no evidence that the disease affects the developing fetus or is associated with complications during childbirth. After being diagnosed with MS, facing the uncertainty of disability down the road, some women may decide that it’s better to start a family sooner rather than later. However, a doctor may recommend going on an MS medication for a year or two before trying to get pregnant. This is to prevent an MS relapse during pregnancy or early in the postpartum period. Some medications (such as Tysabri or Gilenya) are generally avoided because there’s a risk of an MS flare-up once they’re stopped. But other medications (such as the injectable MS meds) can be taken right up until pregnancy and can reduce the risk of having a relapse.

A new Italian study now provides additional support for this strategy (Portaccio and colleagues. ECTRIMS 2019; abstract P410). The researchers looked at 335 pregnancies over a 6-year period. They found that women who developed disability after childbirth had more relapses in the year before pregnancy. In one-third of cases, disability had already started to worsen beforehand. In contrast, women who were relapse-free in the year before pregnancy were less likely to experience worsening disability in the first few years after childbirth.

Pregnancy and breastfeeding are known to have a protective effect. There is a lower risk of relapses, likely because of hormonal effects during pregnancy and lactation. But this study is the first to indicate that the year before pregnancy is also important. These findings underscore the importance of planning a pregnancy. One of the best resources for developing a pregnancy plan is an MS nurse, who can provide advice on the best wellness strategies (including medications) for the health of mother and baby.

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