Family planning considerations in people with multiple sclerosis.

Multiple sclerosis is often diagnosed in patients who are planning on having children. Although multiple sclerosis does not negatively influence most pregnancy outcomes, less is known regarding the effects of fetal exposure to novel disease-modifying therapies (DMTs). The withdrawal of some DMTs during pregnancy can modify the natural history of multiple sclerosis, resulting in a substantial risk of pregnancy-related relapse and disability. Drug labels are typically restrictive and favour fetal safety over maternal safety. Emerging data reporting outcomes in neonates exposed to DMTs in utero and through breastfeeding will allow for more careful and individualised treatment decisions. This emerging research is particularly important to guide decision making in women with high disease activity or who are treated with DMTs associated with risk of discontinuation rebound. As increasing data are generated in this field, periodic updates will be required to provide the most up to date guidance on how best to achieve multiple sclerosis stability during pregnancy and post partum, balanced with fetal and newborn safety.

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Declaration of interests KMK has received grants from the MS Society of Canada; speaking or consulting fees from Biogen, EMD Serono, Novartis, and Roche; and is an advisory board member for Biogen, Novartis, and Roche, outside the submitted work. RD has received payments to her institution, including grants from Biogen, Merck, Celgene, National MS Society, MS Society UK, Horne Family Trust, and the BMA Foundation; honoraria from Biogen, Janssen, Merck, Novartis, Roche, Sanofi, and Teva; participated on an advisory board for Biogen, Janssen, Merck, Novartis, and Roche; and received support for attending meetings or travel from Biogen, Janssen, Merck, Novartis, Roche, and Sanofi, outside the submitted work. MPA received grants for a sponsored statistician from Merck; consulting fees from Almirall, Bayer Schering Pharma, Biogen-Idec, Sanofi Genzyme, Merck-Serono, Novartis, and Roche; honoraria from Almirall, Bayer Schering Pharma, Biogen-Idec, Merck-Serono, Novartis, Roche, and Sanofi-Genzyme; participated on the data safety and monitoring board or advisory board for Merck, Novartis, Roche, and Sanofi Genzyme; and reports a leadership role as president of The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), outside the submitted work. RB received investigator-initiated grants from Biogen, Novartis, and F Hoffman LaRoche, and sponsored grants from F Hoffman LaRoche; consulting fees from Alexion, Biogen, EMD Serono, Novartis, F Hoffman Laroche, Genzyme Sanofi, TG Therapeutics, and Janssen. AIC received speaker's honoraria from Bayer Healthcare; and support for attending meetings from Teva, outside the submitted work. MM received grants from the Danish MS Society; consulting fees from Merck, Sanofi, Roche, and Novartis; payment or honoraria from Merck, Sanofi, Roche, Novartis, Biogen, and Bristol Myers Squibb; and participated on the data safety and monitoring board or advisory board for Merck, Sanofi, Roche, Novartis, Biogen, and Bristol Myers Squibb, outside the submitted work. ST received speaker honoraria from Bayer Healthcare and Biogen GmbH, and manuscript writing assistance from Hexal AG, outside the submitted work. MT received grants for a sponsored statistician from Biogen; consulting fees from Almirall, Bayer Schering Pharma, Biogen-Idec, Genzyme, Janssen, Merck-Serono, Novartis, Roche, Sanofi-Aventis, Viela Bio, and Teva Pharmaceuticals; honoraria from Almirall, Bayer Schering Pharma, Biogen-Idec, Genzyme, Janssen, Merck-Serono, Novartis, Roche, Sanofi-Aventis, Viela Bio, and Teva Pharmaceuticals; and reports a leadership role as ECTRIMS vice president, outside the submitted work. SV has received payments to her institution including grants from Biogen, Janssen, Merck, Novartis, Roche, and Sanofi; consulting fees from Biogen, Bristol-Myers Squibb, Celgene, Janssen, Merck, Novartis, Roche, and Sanofi; honoraria from Biogen, Merck, Novartis, Roche, Sanofi, and Teva; participated on the data safety and monitoring board or advisory board for Biogen; support for attending meetings or travel from Biogen, Merck, Novartis, and Roche, outside the submitted work. KH received grants or contracts from Almirall, Biogen, Merck, Novartis, Sanofi Genzyme, Roche, and Teva; payment or honoraria from Almirall, Bayer, Biogen, Merck, Novartis, Sanofi Genzyme, Roche, Teva, Janssen, and Bristol-Myers Squibb; support for attending meetings or travel from Bayer, Biogen, Merck, Roche, Sanofi Genzyme, and Teva; participation on a data safety and monitoring board or advisory board from Biogen, Teva, Roche, Novartis, Jansen, and Merck, outside the submitted work. RA, YF, MH, VGJ, AA, VP declare no competing interests.