Which MS treatments are safe during pregnancy at 33?

Question

Hello doctor,

My 33-year-old daughter was diagnosed with relapsing-remitting multiple sclerosis (MS) two years ago, and she is struggling with treatment decisions, especially regarding pregnancy planning. Her first attack was optic neuritis with vision loss that partially recovered after steroids. The second relapse involved numbness and weakness in her legs that required hospitalization. MRI (magnetic resonance imaging) shows multiple lesions in the brain and cervical spine consistent with MS.

The neurologist recommended starting interferon, but she developed severe flu-like symptoms and depression. She tried Glatiramer acetate, but the injection site reactions were terrible, and she dreads daily shots. Newer oral medications like Dimethyl fumarate caused flushing and gastrointestinal upset that she could not tolerate. She has been relapse-free for eight months but is worried about disease progression without treatment.

She wants to get pregnant soon, but most multiple sclerosis medications need to be stopped during pregnancy. Her sister also has an autoimmune disease, so genetic counseling was recommended. Fatigue is her most prominent symptom, affecting her work performance and relationships.

What multiple sclerosis treatments are safest for women planning pregnancy?
Will the disease get worse during pregnancy?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Treatment decisions in multiple sclerosis (MS) become especially challenging when pregnancy is being planned. To reassure you, many women with MS do well during pregnancy, and pregnancy itself is often protective as it reduces the risk of relapses. However, there can be a slightly higher chance of relapse in the first few months after delivery.

Regarding treatment options:

Interferons and Glatiramer acetate have the longest safety data and are generally considered safer if treatment continues until conception or sometimes even during pregnancy. They are often the first choices when pregnancy is being planned.

Most newer oral medications are not recommended during pregnancy and should be stopped well in advance. If her MS is stable, sometimes doctors may advise stopping medication once pregnancy is confirmed and closely monitoring her. Continuing a safer option may be considered if disease activity has been aggressive. Steroids can be used safely during pregnancy to treat relapses if needed.

It is also very important that she plans her pregnancy under the guidance of her neurologist, maintains good vitamin D levels, eats balanced meals, manages fatigue with proper rest, and follows up closely before, during, and after pregnancy to detect relapses early.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.