Fertility, pregnancy and childbirth in women with multiple sclerosis: a population-based study from 2018 to 2020

Abstract

BackgroundWe aim to evaluate whether fertility, pregnancy, delivery and breastfeeding have been actually improving in women with multiple sclerosis (MS), compared with general population, and in relation to treatment features.MethodsWe included 2018–2020 population-level healthcare data on women with MS living in the Campania region (Italy). Fertility, pregnancy and delivery outcomes were obtained from Certificate of Delivery Assistance; breastfeeding was collected up to 6 months after delivery by trained personnel.ResultsOut of 2748 women with MS in childbearing age, 151 women delivered 156 babies. Fertility rate was 0.58 live births per woman with MS, compared with 1.29 in Campania region and 1.25 in Italy. Disease-modifying treatment (DMT) continuation during pregnancy was associated with lower birth weight (coeff −107.09; 95% CI –207.91 to –6.26; p=0.03). Exposure to DMTs with unknown/negative effects on pregnancy was associated with birth defects (OR 8.88; 95% CI 1.35 to 58.41; p=0.02). Birth defects occurred in pregnancies exposed to dimethyl fumarate (2/21 exposed pregnancies), fingolimod (1/11 exposed pregnancies) and natalizumab (2/30 exposed pregnancies). After delivery, 18.8% of women with MS were escalated of DMT efficacy, while 50.7% started on same/similar-efficacy DMTs, and 30.5% did not receive DMT. The probability of breastfeeding was higher in women who were treated with breastfeeding-safe DMTs (OR 5.57; 95% CI 1.09 to 28.55; p=0.03).ConclusionsFertility rate in women with MS remains below the general population. Family planning and subsequent DMT decisions should aim to achieve successful pregnancy, delivery and breastfeeding outcomes, while controlling disease activity.

Pregnancy and fetal outcomes following maternal exposure to glatiramer acetate in all three trimesters of pregnancy

“…However, until now, data on DMT use throughout pregnancy were limited. In two recently published cohort studies, pregnancy outcomes were examined following exposure to DMT but not necessarily throughout pregnancy [12, 13]. These studies found a small increased risk of several pregnancy outcomes, but MCM risk differed between the studies.…”

Monoclonal Antibodies in Pregnancy and Breastfeeding in Patients with Multiple Sclerosis: A Review and an Updated Clinical Guide

“…Although there are a few studies suggesting that maternal MS is associated with an increased risk of adverse pregnancy or neonatal outcomes, it is well established that it does not affect fertility, nor does it increase the risk of miscarriage [ 6 , 7 , 8 , 9 ]. However, limited evidence on the relative safety of DMT in pregnancy for both mother and baby has led many women to either interrupt DMT or delay treatment initiation until after they have completed their families.…”