Women of childbearing age are, compared to men, underrepresented in MS therapy. This was shown by a recent study. There is a gender gap in the use of immunomodulatory therapies (DMT). However, this does not have to be the case.
Because: Pregnancy and MS do not exclude each other. – Nowadays, with cleverly planned immunotherapy, it is usually possible to ensure pregnancy and breastfeeding despite MS. – A significant danger for mother and child does not need to be feared: Neither does the mother have to fear a health hazard due to relapses after delivery, nor is there damage to the unborn child from taking immunotherapies. See also previous reports on MS-Docblog about MS therapy and desire to have children or pregnancy:
- Pregnancy and highly effective MS therapy
- ECTRIMS 2022 (2) – Pregnancy and breastfeeding
- Approval change of interferon-beta therapy during pregnancy and breastfeeding
Gender gap in MS therapy scientifically measured
However, it is essential that MS is stable in the last year before conception – because women with poorly controlled disease and disease activity before pregnancy have a high risk of suffering relapses during pregnancy or post-partum. Accordingly, women of childbearing age should therefore be consistently and efficiently treated with immunotherapy – well-controlled MS is the best prerequisite for a safe pregnancy.
Against this background, the results of a recently published French study (Gavoille et al. Neurology 2025 Aug 26;105(4):e213907) are worrying, because the data show exactly the opposite: In clinical reality, MS therapy is influenced by the expectation of a future pregnancy in such a way that there is rather an undersupply of disease-modifying therapies (DMT), especially highly effective DMT, compared to men.
The authors included a total of 22,657 patients with MS in the study, of which 16,857 (74.4 %) were female. The mean age at diagnosis was 29.0 years, the average observation period was 11.6 years. Women received DMT significantly less often. The difference was noticeable after 1 year for highly effective therapies (e.g. anti-CD20 antibodies), and only after 2 years for moderately effective therapies. The proportion of treated women (from the first delivery of 5,268 women) began to drop from 42.6 % to 27.9 % at the estimated time of conception 18 months before delivery.
An analysis presented at the last ECTRIMS meeting (Houtchen et al. P589; ECTRIMS 2025) shows similar results: For this retrospective analysis, billing data from IQVIA PharMetrics® Plus from women with MS aged ≥ 18 years and ICD-10 diagnosis codes for live births from October 1, 2017 to December 31, 2023 were used. The use of DMT was evaluated during the time before conception (≤ 1 year before conception), pregnancy (≤ 40 weeks after live birth) and ≤ 6 months after delivery.
Increase in B-cell-depleting therapies
Here too, it was found that almost half of the women with MS were untreated during the time before conception (42 %), during pregnancy (60 %) and after birth (57 %). However, there is a pleasing increase in the use of B-cell depleting therapies, while the use of less effective DMTs declined between 2019 and 2023.
This reflects a growing confidence in the benefit-risk profile of highly effective therapies. Recent data show that female patients with a desire to have children can be effectively protected from inflammatory activity in all phases of a pregnancy – from conception well into the postpartum phase – with the highly effective anti-CD20 antibodies, without this being associated with a specific threat to the child. In addition, a pregnancy free of administration is possible at the same time.
Despite this positive trend, however, there is still a lot of room for improvement in the treatment of women with a desire to have children in view of the data. The data show how important education and information on the subject of pregnancy and MS or pregnancy and immunotherapy continues to be. This is a core task in the treatment of MS patients.
This post was translated from German to English with the help of AI.
