Pregnancy in the Setting of Multiple Sclerosis

This article provides a review of the available data on reproductive issues that arise in patients with multiple sclerosis (MS).Recent findings have replicated earlier findings that pregnancy and possibly breast-feeding bring about a favorable immunomodulatory effect in patients with MS. Use of disease-modifying therapies prior to pregnancy may further decrease a patient's risk for postpartum disease activity.The annualized relapse rate in MS decreases during pregnancy, with a nadir in the third trimester, and rebounds significantly in the 3-month postpartum period. Exclusive breast-feeding may exert a beneficial effect in decreasing the postpartum risk for relapse. Certain assisted reproductive technology methods are thought to increase the risk for relapse. Disease-modifying therapies are generally discontinued during pregnancy and lactation with a few exceptions. The pregnancy course is usually routine without significant obstetric complications, and babies, although slightly smaller, are typically healthy.