The desire to have children and MS is an important topic. Today, all experts agree that people with MS should be intensively supported on this subject. Everything should be done to realize the desire to have children safely and smoothly despite MS. By now, it should also be known that MS patients can become pregnant just like those who are not affected. They also give birth to healthy children just as often, can usually give birth normally and can, of course, receive epidural anesthesia (PDA) if needed. In principle, I would always recommend realizing the desire to have children from a stable phase of the disease, but this is actually the only restriction that comes to mind in connection with the desire to have children and MS.
However, there is still uncertainty about the topic of pregnancy and MS, often related to the (planned) MS medication. Most often it is about which drugs can be used safely and what is the best strategic approach. Therefore, I would like to briefly summarize the most important facts again.
Basically, for all preparations (except Copaxone), the package insert states that you should not become pregnant while taking the medication in question. However, it often also states that a careful risk-benefit assessment can consider pregnancy even despite medication.
Since maximum protection is also sought for the mother, it has become established to maintain some of the preparations until pregnancy occurs and then discontinue them. Since relapses are significantly reduced during pregnancy, this approach usually provides a good compromise between the mother’s health and protecting the unborn child from medication. This procedure is useful for all interferon preparations (Betaferon, Rebif, Avonex, Plegridy) and for Dimethyl Fumarate (Tecfidera), but it is also carried out for Glatiramer Acetate (Copaxone), although this substance – as already mentioned above – has now been classified as unproblematic.
The above-described procedure should not be used with Teriflunomide (Aubagio) and Fingolimod (Gilenya). Although the data that exist on pregnancies under these preparations are surprisingly inconspicuous, both preparations have at least a theoretical potential for danger due to their mechanism of action. Therefore, both substances should be discontinued before conception. With Teriflunomide (Aubagio), there is the possibility of washing out the substance with cholestyramine in the event of a pregnancy, which should also be done immediately. Fingolimod (Gilenya) should be stopped immediately if an unplanned pregnancy occurs.
Natalizumab (Tysabri) is a substance for treating very active MS courses – if you stop the substance, the disease activity returns. Since very active MS patients are usually treated with Natalizumab, in recent years it has become common practice to continue Tysabri during pregnancy for the sake of the mother’s health. Often, the protection of pregnancy is not sufficient for patients with Natalizumab: if the drug is discontinued already at the onset of pregnancy, it often leads to relapses during pregnancy, which is very stressful for all involved. The available safety data justify this approach, although it must always be an individual decision (see also the article Pregnancy in highly active MS).
If you have received Alemtuzumab, you can plan a pregnancy relatively well. You should not get pregnant in the first month after the infusion cycle, but from the 4th month after the infusion it is possible – the substance is no longer detectable in the body. Moreover, in the best case, you will also have a rest from the disease after Alemtuzumab and initially do not have to take any further medication – so it is a favorable period to realize a desire to have children.
Taking Cladribin requires safe contraception during tablet intake – beyond that, no child should be conceived half a year after the last intake, which applies to men as well as women. Accordingly, the desire to have children has to be postponed by about 1.5 years if you choose Cladribin as your MS medication. After that, however, the medication promises a therapy-free remission for the following years. This is also a favorable situation for an existing desire to have children.
For Ocrelizumab (Ocrevus) the situation is somewhat confusing at present. The medication is effective and has good safety data – so it is a very attractive concept for treating relapsing MS patients. The European product information states that one should not become pregnant for 1 year after administration of Ocrelizumab. Since Ocrelizumab must be given every 6 months, this would mean that one should not become pregnant at all if one is treated with this medication – and this is of course not pragmatic. In contrast, the American product information states that one should not become pregnant for only 6 months. This is feasible, as a pregnancy shortly before the next cycle is then possible. Such a procedure is then in compliance with the regulations and one can still treat with this innovative medication. Hopefully, the European product information will be revised accordingly at some point.
In short, these were the most important recommendations for MS medications and pregnancy. If there are any uncertainties on this important topic, talk to your neurologist to get clear answers to these important questions.