Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, predominantly
affecting women of childbearing age. Therefore, issues of conception, pregnancy, and
delivery are of significant importance to patients and treating physicians. We discuss
immunologic and clinical effects of pregnancy on the course of MS including both immunosuppression
on a local level and a heightened state of immunocompetence on a global level. Clinical
outcomes of the Pregnancy in Multiple Sclerosis trials are reported. We analyze and
update the available data on safety and efficacy of immunomodulating MS treatments
and symptomatic treatments for pregnant and lactating women, and address specific
issues of MS management at the time of pregnancy. We review the data related to estrogen-based
MS therapies currently or previously in trials. Pregnancy does not appear to be associated
with adverse outcomes in MS patients. Some evidence suggests possible beneficial effects,
although clear prospective data of sufficient length and quality are limited. Long-term
relapse rates or disability progression do not seem to be affected by pregnancy in
MS patients. The use of immunosuppressive or immunomodulatory agents in pregnancy
is not routinely advisable but could be considered under special circumstances.
Keywords
multiple sclerosis - pregnancy - treatment - outcomes
