N.V. KHACHANOVA

Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of the Russian Federation, Moscow

Contact details:

Khachanova N.V. — Candidate of Medical Sciences, Professor of the Department of Neurology, Neurosurgery and Medical Genetics

Address: 10 Pistsova St., Moscow, Russian Federation, 127015, tel.: +7-926-215-27-34, e-mail: voroba.nat@mail.ru

Over the past decades, issues related to pregnancy with multiple sclerosis (MS) have arisen even more interest. MS is more common in women than in men, and usually begins at childbearing age. Current treatment options for MS are constantly expanding. The emergence of new drugs that change the course of MS (MSDMD, multiple sclerosis disease modifying drugs), which have different mechanisms of action, necessitates the collection of information about their effect on pregnancy and the risks to the developing fetus.

Material and methods. This article provides an overview of the available information on the use of MSDMD during pregnancy, with particular emphasis on fertility, fetal development, pregnancy outcomes, and breastfeeding.

Results. Most of MSDMD are not recommended during pregnancy, but can be used in cases where the potential benefits to the mother outweigh the potential risks to the fetus. First-line injectable drugs, such as glatiramer acetate and interferon beta, can be continued during pregnancy. Teriflunomide is contraindicative during pregnancy, and dimethyl fumarate should be avoided as far as possible. Therapy with fingolimod should be discontinued 2 months before the planned conception with the obligatory observance of contraception during the «washing period». Patients taking natalizumab, as a rule, have a highly active course of MS before treatment, so given the significant risk of reactivation of the disease, a balanced decision should be made if treatment is continued until 30 weeks of gestation. Pregnancy is not recommended for 4 months after the administration of alemtuzumab and for 6 months after the infusion of ocrelizumab.

Key words: fertility, pregnancy, safety, therapy of multiple sclerosis, lactation.

(For citation: Khachanova N.V. Therapy of multiple sclerosis and the desire to have a baby — is there a problem of choice? Practical Medicine. 2019. Vol. 17, № 7, P. 18-27)

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