Tuesday, 5 June 2012

Research: pregnancy and exposure to DMT

Epub: Fragoso et al. The effects of long-term exposure to disease-modifying drugs during pregnancy in multiple sclerosis.Clin Neurol Neurosurg. 2012 May 25.

BACKGROUND AND OBJECTIVE: Women with multiple sclerosis (MS) who intend to get pregnant are often advised to discontinue disease modifying therapy (DMT) prior to conception. This recommendation is not based on medical evidence and may interfere with disease control by immunomodulatory drugs. The present study was designed to help discuss the effect of DMT for MS on pregnancy and on disease course.

PATIENTS AND METHODS: Retrospective data from 152 pregnancies of 132 women with MS were collected by the physician in charge of the case. All data were entered into a specific file for qualitative and quantitative statistical analysis.

RESULTS: From the total group of patients, 89 pregnancies occurred without any exposure to MS drugs, while 61 pregnancies occurred with at least eight weeks of exposure to MS immunomodulatory drugs. The rate of obstetric and neonatal complications was similar in both groups, except for the newborn weight and height which was smaller for mothers receiving medications. Mothers' post-delivery relapse rate and EDSS scores in the follow-up period were significantly higher in the absence of treatment.

CONCLUSION: It is possible that, with further such supportive data, international guidelines on MS treatment in young women who intend to get pregnant may need to be revised.


"Can woman with MS fall pregnant on DMTs? No company is able to recommend that their product is safe during pregnancy. The latter is particularly important for the emerging small molecules. However for biological therapies the evidence is less clear. The need for a long washout period for IFNbeta and glatiramer acetate seem unnecessary as the half-life of these products within the body is limited to days. I only recommend a washout period of days. There are also an increasing number of successful pregnancies that have occurred whilst MSers are on glatiramer acetate with no obvious untoward effects. The most experience with the latter has occurred in Germany and a large number of German neurologists are now switching woman onto glatiramer acetate prior to them falling pregnant and then continuing the drug through pregnancy. Another important emerging strategy will be induction therapies; drugs that are given once or twice and have a prolonged effect on MS that will allow MSers to conceive and have a family. Alemtuzumab is the one drug from this category that is likely to be licensed first."

Other pregnancy posts of interest on this blog

Research: pregancy does not appear to influence your MS fate, 27 May 2012; Prospective studies have reported a significant decline by two-thirds in the rate of relapses during the third trimester of pregnancy and a significant increase by two-thirds during the first 3 months post-partum (after delivery).

Multiple Sclerosis Research: Pregnancy outcomes in MS'ers on DMTs, 16 Sep 2011; 21/101 (21%) of births to MS women treated with DMD prior to pregnancy were exposed to a DMD. In all cases, exposure was documented as unintentional and DMD treatment was stopped within 2 months of gestation.

Multiple Sclerosis Research: Vitamin D intake during pregnancy is ..., 28 Jul 2011; This allowed these investigators to study the association of maternal milk intake, maternal dietary vitamin D intake, and predicted maternal serum vitamin D during pregnancy and their daughters' risk of developing MS.

Article of interest (6) - Effect of pregnancy on relapses, 15 Jul 2011; The average or mean rate of relapse was 0.7 per year in the year before pregnancy, 0.5 during the first trimester, 0.6 during the second trimester and 0.2 during the third. The rate increased to 1.2 during the first three months ...

Multiple Sclerosis Research: Pregnancy and natalizumab: results of ..., 1 May 2011; Of the women exposed to natalizumab during pregnancy, 29 women gave birth to 28 healthy children; one child was born with hexadactyly (an extra finger), 5 pregnancies ended in an early miscarriage and one woman ...

Article of interest (7): Pregnancy is associated with a better prognosis, 16 Jul 2011; "Because of this study, and the fact that pregnancy itself reduces the attack rate, researcher's have been trying to find out what it is about pregnancy that is so beneficial for MS'ers." "We assume that the profound changes that ...

Pregnancy and foetal outcomes after interferon-β exposure in multiple, 20 Dec 2010; Pregnancy and foetal outcomes after interferon-β exposure in multiple sclerosis. A report on 88 pregnancies in Italian woman that were exposed to interferon-beta (average exposure 4 to 5 weeks) has demonstrated that ...

Multiple Sclerosis Research: Schtop or Not. Pregnacy and MS, 05 Aug 2011; Therefore no adverse effects of pregnancy on MS was found in the mid to long term. Conclusions. Therefore Good News, having a baby is not going to affect your MS. "Why does MS go away during pregnancy?". Your baby is ...

Multiple Sclerosis Research: Research:MS in Women, 23 May 2012; METHODS: In 2001, 35794 mothers of participants of the Nurses' Health Study II completed a questionnaire inquiring about their experiences and diet during pregnancy with their nurse daughters. We studied the association ...

Multiple Sclerosis Research: Breastfeeding is not related to ..., 13 Jul 2011; The only significant predictor of having a relapse after childbirth was an increased number of relapses in the year before pregnancy and during the pregnancy itself. Therefore, the reported association between breastfeeding ...

Delivery of healthy babies after natalizumab use for multiple sclerosis, 18 Apr 2011; The authors describe the pregnancy and outcome in two women with MS using natalizumab. The first patient ... The second patient did not experience MS relapses during pregnancy, while still using natalizumab. Importantly ...

Reduced maternal UV exposure contributes to MS risk in later life, 30 Apr 2010; Judith Staples and colleagues show that low maternal exposure to ultraviolet radiation in the first trimester of pregnancy is independently associated with subsequent risk of MS in their offspring in Australia. The adjusted ...

Multiple Sclerosis Research: Caesarian section and MS, 13 Oct 2011; Background: Pregnancy related factors are believed to contribute to the risk of developing MS. Objective: ... Could the factor or factors that predispose to MS risk in pregnancy also predispose to caesarian section? Any ideas?" ...

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