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Pregnancy in the Setting of Multiple Sclerosis

Fabian, Michelle MD

doi: 10.1212/CON.0000000000000328
Review Articles

Purpose of Review: This article provides a review of the available data on reproductive issues that arise in patients with multiple sclerosis (MS).

Recent Findings: Recent findings have replicated earlier findings that pregnancy and possibly breast-feeding bring about a favorable immunomodulatory effect in patients with MS. Use of disease-modifying therapies prior to pregnancy may further decrease a patient’s risk for postpartum disease activity.

Summary: The annualized relapse rate in MS decreases during pregnancy, with a nadir in the third trimester, and rebounds significantly in the 3-month postpartum period. Exclusive breast-feeding may exert a beneficial effect in decreasing the postpartum risk for relapse. Certain assisted reproductive technology methods are thought to increase the risk for relapse. Disease-modifying therapies are generally discontinued during pregnancy and lactation with a few exceptions. The pregnancy course is usually routine without significant obstetric complications, and babies, although slightly smaller, are typically healthy.

Address correspondence to Dr Michelle Fabian, Mount Sinai Hospital, 5 E 98th St, Box 1138, New York, NY 10029, michelle.fabian@mssm.edu.

Relationship Disclosure: Dr Fabian reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Fabian discusses the unlabeled/investigational use of glatiramer acetate in pregnancy.

© 2016 American Academy of Neurology
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