MS Medications and Pregnancy - dummies

By Rosalind Kalb, Barbara Giesser, Kathleen Costello

With or without a multiple sclerosis (MS) diagnosis, the goal during pregnancy is always to be taking as few medications as possible in order to avoid problems for your growing baby. Before trying to become pregnant, be sure to discuss all the medications you’re taking (prescription and over-the-counter) with your physician so that changes or substitutions can be made prior to conception if needed.

Don’t use disease-modifying MS medications when pregnant or planning pregnancy

Early and ongoing treatment with one of the disease-modifying therapies — the interferon medications, Copaxone (glatiramer acetate), Gilenya (fingolimod), Novantrone (mitoxantrone) or Tysabri (natalizumab) — is important to controlling your disease. But here’s the hitch: None of these medications are approved by the FDA for use during pregnancy or breastfeeding.

Glatiramer acetate (Copaxone) has been designated a Category B pregnancy risk (which means no evidence of pregnancy or fetal risk in animal studies or in clinical trials in humans). The interferons and natalizumab are Category C drugs (which means some evidence in animal studies of possible harm to the fetus).

For safety reasons, the effects of the disease-modifying medications can’t be studied during pregnancy. But the data that have been collected so far from women who became pregnant accidentally while on an interferon medication, Copaxone, or Tysabri showed no increased risks compared to the general population.

Nevertheless, most neurologists and obstetricians still recommend that women stop any of these medications prior to becoming pregnant. At this time, no pregnancy data have been collected from women taking Gilenya, but it’s also designated as a Category C drug and isn’t considered safe for use by pregnant women. We give women and men more info about Novantrone in the next section.

Until more information becomes available, we strongly recommend that you stop your disease-modifying therapy at least one month prior to trying to conceive (after consulting with your doctor, of course). And you should consult with your doctor right away if you become pregnant unexpectedly while on medication.

If you haven’t yet started a disease-modifying medication and are considering becoming pregnant within the coming year, you may want to wait until your baby is born to begin treatment in order to avoid having to start and stop.

But you don’t need to panic about being without your meds because pregnancy hormones actually provide some protection against MS disease activity. In fact, pregnancy hormones reduce relapses by about the same amount as the disease-modifying therapies.

Unfortunately, most of the pharmaceutical companies haven’t paid any attention to medication issues for men. No data have been collected regarding babies who were conceived while a father was taking one of the disease-modifying medications.

Most physicians aren’t concerned about the impact of the father’s medications on the baby — but, if you prospective fathers want to be super-careful, you can talk to your physician about interrupting your medication schedule while you and your partner are trying to conceive.

Effects of immunosuppressant MS medications on fertility

Novantrone (mitoxantrone) and other immunosuppressant medications that are used to treat some progressive forms of MS are designated Category D medications by the FDA. They can affect egg and sperm production. They can also harm a developing fetus.

So, women should take a pregnancy test prior to starting any of these medications (and prior to subsequent doses of those medications that are taken every several months). Also, because of the potential of these drugs to cause sterility, men should consider banking sperm and women should consider harvesting their eggs for future use.

MS medication options during and after pregnancy

It’s great that pregnancy hormones provide some protection against MS disease activity during pregnancy, but what do you do while you’re trying to get pregnant or if you choose to breastfeed? During these months you’re obviously not receiving any protection against disease activity, so as you make your family-planning decisions, you need to be thinking about how long you want to be off your medication.

For example, if your MS has been particularly active in the year prior to your pregnancy and it remains active during your pregnancy, you may want to consider getting back on medication as soon as you deliver, which means that you’ll have to bottle-feed your baby rather than nurse. Some neurologists are also prescribing intravenous immunoglobulin (IVIg) right after delivery to reduce the risk of relapses. However, if your MS has been pretty stable, you can probably postpone medication until you decide to stop nursing.