The diagnosis of MS in young adults often occurs during their reproductive years, making concerns about family planning and MS treatment in relation to pregnancy and breastfeeding common. While pregnancy alone is not harmful for patients with MS, the potential impact of disease-modifying treatments (DMTs) on maternal and fetal health necessitates pre-conception counseling.

Alise Carlson, MD, and colleagues recently developed a resource based on a consensus-building initiative for patients with MS who are considering pregnancy. This frequently-asked-questions approach provides clear information that physicians can apply to their interactions with patients with MS.

The resource covers 20 questions related to MS and reproductive issues. Many of the questions are specific to women and include treatments considered to be safe during pregnancy, breastfeeding, the safety of MRI during pregnancy and breastfeeding, and the resumption of treatment after delivery. However, there are also topics that focus on men, including the necessity of contraception with certain DMTs due to fetal teratogenicity and the potential effect of autologous hematopoietic stem cell transplant on fertility. Other topics applicable to both men and women include the genetic risk of MS for children of people with the disease.

Timing, communication, and collaboration are three recurring themes in the article by Dr. Carlson and colleagues. The research team also emphasizes the importance of clinicians familiarizing themselves with pregnancy-related risks associated with MS therapies, as well as the identification and management of MS-related reproductive issues. Many of the risks to the fetus that are associated with DMTs are still unknown due to limited data. However, by collaborating with a medical team that understands these issues, family planning need not be removed from a patient’s hopes for their future.

Dr. Carlson discussed the impact of the study team’s findings with Physician’s Weekly.

Physician’s Weekly: What prompted this research?

Dr. Carlson: MS is most often diagnosed during a person’s childbearing years. Due to potential adverse effects and fetal toxicities associated with certain DMTs, providers must be knowledgeable about how to counsel patients effectively regarding plans for pregnancy (Table).

PW: How can physicians address family planning among patients with MS?

Dr. Carlson: Family planning, including plans for pregnancy and the desire to have children in the future, should be discussed with all patients—both men and women—who are newly diagnosed with MS. A multidisciplinary approach, combining the expertise of neurologists, obstetricians, gynecologists, and family practitioners, is important in achieving success for both mother and baby.

PW: Is there anything else you would like to mention?

Dr. Carlson: Patients with MS can become pregnant and have normal pregnancies. Although many DMTs used for the treatment of MS are associated with potential fetal toxicity and teratogenicity, pre-emptive counseling, proper timing of pregnancy, and careful selection and administration of DMTs can minimize these risks.