Safety of Taking DMTs While Pregnant

September 4, 2025

Susana Cummings

Illustration of a woman with a white coat and a stethoscope around her neck and a pregnant woman with her hands on her abdomen, below a heart. — Image: iStock

Consortium of Multiple Sclerosis Centers’ 2025 meeting.“Historically, we've taken people off their therapies, gotten MRIs and, ‘Oops. There's new brain injury.’ And that's reactive management,” says Riley Bove, MD, a neurologist at the University of California, San Francisco and associate professor at its Weill Institute for Neurosciences. With proactive management, she adds, women who want children weigh risks and benefits with their healthcare team. Then, together, they make decisions that keep their MS from progressing while protecting their babies.Doctors used to advise women with MS against having children. But in recent years, a greater understanding and better counseling of patients has led to more pregnancies after an MS diagnosis, Bove says.Evolving scientific guidance suggests that, with the right timing and careful medical supervision, some disease-modifying therapies (DMTs) may allow women living with MS to plan the families they want, Bove says.That doesn’t mean that women should continue with their whole MS treatment during pregnancy. Rather, Bove adds, with their healthcare professionals, they can now plan the timing of timing of medications to control the disease and, at the same time, prevent passing them to their babies through the placenta." c-nmssatomrichtext_nmssatomrichtext-host="">

Based on the latest evidence and with careful planning with their doctors, women with multiple sclerosis may use some disease-modifying treatments right before getting pregnant, during pregnancy and soon after to avoid relapses and disability without putting their babies at risk, according to a leading expert at the Consortium of Multiple Sclerosis Centers’ 2025 meeting.“Historically, we've taken people off their therapies, gotten MRIs and, ‘Oops. There's new brain injury.’ And that's reactive management,” says Riley Bove, MD, a neurologist at the University of California, San Francisco and associate professor at its Weill Institute for Neurosciences. With proactive management, she adds, women who want children weigh risks and benefits with their healthcare team. Then, together, they make decisions that keep their MS from progressing while protecting their babies.Doctors used to advise women with MS against having children. But in recent years, a greater understanding and better counseling of patients has led to more pregnancies after an MS diagnosis, Bove says.Evolving scientific guidance suggests that, with the right timing and careful medical supervision, some disease-modifying therapies (DMTs) may allow women living with MS to plan the families they want, Bove says.That doesn’t mean that women should continue with their whole MS treatment during pregnancy. Rather, Bove adds, with their healthcare professionals, they can now plan the timing of timing of medications to control the disease and, at the same time, prevent passing them to their babies through the placenta.

MS Disease and Pregnancy

during pregnancy, and women should stop using them before they conceive or when they get a positive pregnancy test result, according to Practical Considerations for Managing Pregnancy in Patients With Multiple Sclerosis by Bove and other experts. But some treatments may help women with severe or highly active MS remain stable during pregnancy in cases where benefits outweigh the risk to the fetus, according to the review. Among DMTs, the drugs with the most evidence on safe usage during pregnancy are interferon beta and glatiramer acetate." c-nmssatomrichtext_nmssatomrichtext-host="">

With MS, the immune system, which protects the body from infection, has an abnormal response and causes inflammation that damages the central nervous system. But during pregnancy, since half of the baby’s genetic code comes from the father, the immune system of most women with the disease shifts into a state that allows the baby to grow and develop, Bove explains. About 3 out of 4 people with MS are women, and diagnoses usually come during their reproductive years. Research supports early and ongoing DMTs to limit inflammation, reduce relapses and slow disability in people with MS, in general.But the U.S. Food and Drug Administration (FDA) has not approved the use of any DMTs during pregnancy and recommends against using them while breastfeeding. This may be, in part, because pregnant women are not usually allowed to participate in MS clinical trials, experts say.Many DMTs do have some known risks during pregnancy, and women should stop using them before they conceive or when they get a positive pregnancy test result, according to Practical Considerations for Managing Pregnancy in Patients With Multiple Sclerosis by Bove and other experts. But some treatments may help women with severe or highly active MS remain stable during pregnancy in cases where benefits outweigh the risk to the fetus, according to the review. Among DMTs, the drugs with the most evidence on safe usage during pregnancy are interferon beta and glatiramer acetate.

MS Activity During and After Pregnancy

MS symptoms, but that women often have relapses after giving birth. A 2021 study of women with MS found that the rate of relapse goes down during pregnancy, especially the third trimester, but increases during the first 3 months after delivery, before returning to pre-pregnancy levels.According to further studies:

After delivery, without treatment, 1 out of every 3 women has clinical relapses, and 1 out of every 2 has new lesions on MRIs.
Exposure to ocrelizumab (Ocrevus®) during pregnancy and breastfeeding did not increase risks for infants.
Data from a registry showed that the outcomes of women exposed to ofatumumab (Kesimpta®) during pregnancy were similar to those of the general population.
Pregnancy outcomes in 3,722 women with MS found no association between exposure to DMTs and spontaneous abortions, premature births or major congenital defects. MS itself and exposure to some DMTs were associated with low birth weight, while rare severe infections were associated with others.

“We've come a long way, and we have a lot of unfinished business,” Bove says. Among others, more studies on MS and pregnancy in specific groups and comprehensive pregnancy registries are needed, she says." c-nmssatomrichtext_nmssatomrichtext-host="">

In the past, research on women’s health and MS has been limited, but studies over the past decade have given more options to women considering having children, says Bove, a leading expert in women’s health and MS who has received research funding from the National MS Society.Evidence suggests that pregnancy does not worsen MS over time and may even have a beneficial effect on the disease, according to the review.Doctors have long known that pregnancy sometimes may ease MS symptoms, but that women often have relapses after giving birth. A 2021 study of women with MS found that the rate of relapse goes down during pregnancy, especially the third trimester, but increases during the first 3 months after delivery, before returning to pre-pregnancy levels.According to further studies:

After delivery, without treatment, 1 out of every 3 women has clinical relapses, and 1 out of every 2 has new lesions on MRIs.
Exposure to ocrelizumab (Ocrevus®) during pregnancy and breastfeeding did not increase risks for infants.
Data from a registry showed that the outcomes of women exposed to ofatumumab (Kesimpta®) during pregnancy were similar to those of the general population.
Pregnancy outcomes in 3,722 women with MS found no association between exposure to DMTs and spontaneous abortions, premature births or major congenital defects. MS itself and exposure to some DMTs were associated with low birth weight, while rare severe infections were associated with others.

A woman in business attire speaks on a podium in front of a colorful background that reads CMSC. — Riley Bove, MD

After delivery, without treatment, 1 out of every 3 women has clinical relapses, and 1 out of every 2 has new lesions on MRIs.
Exposure to ocrelizumab (Ocrevus®) during pregnancy and breastfeeding did not increase risks for infants.
Data from a registry showed that the outcomes of women exposed to ofatumumab (Kesimpta®) during pregnancy were similar to those of the general population.
Pregnancy outcomes in 3,722 women with MS found no association between exposure to DMTs and spontaneous abortions, premature births or major congenital defects. MS itself and exposure to some DMTs were associated with low birth weight, while rare severe infections were associated with others.

After delivery, without treatment, 1 out of every 3 women has clinical relapses, and 1 out of every 2 has new lesions on MRIs.
Exposure to ocrelizumab (Ocrevus®) during pregnancy and breastfeeding did not increase risks for infants.
Data from a registry showed that the outcomes of women exposed to ofatumumab (Kesimpta®) during pregnancy were similar to those of the general population.
Pregnancy outcomes in 3,722 women with MS found no association between exposure to DMTs and spontaneous abortions, premature births or major congenital defects. MS itself and exposure to some DMTs were associated with low birth weight, while rare severe infections were associated with others.

From the Lab to Doctors’ Offices

guidelines. “We have a massive gap that we need to fill as an MS community, between the science that we have and the delivery of that science to our patients with MS. At what point do we say, 'We have enough guidelines; we need to implement them?’” she asks colleagues.Care to women should not depend on where they live or who they turn to for healthcare, Bove adds." c-nmssatomrichtext_nmssatomrichtext-host="">

Thanks to existing science, instead of being surprised by women’s reproductive transitions, such as pregnancy and menopause, medical professionals can now plan for them and provide care based on it, Bove says.Following prescription labels may not be the most evidence-based way to handle DMTs during pregnancy, she says. Guidance by the FDA is often inconsistent with the European Medicines Agency’s recommendations. Sometimes, indications don’t make sense or differ among similar medications, she adds.Research has generated more real-world data to guide doctors and, at the same time, offer stability to pregnant women with MS and prevent additional disability, according to Bove. However, some neurologists still do not review or apply guidelines. “We have a massive gap that we need to fill as an MS community, between the science that we have and the delivery of that science to our patients with MS. At what point do we say, 'We have enough guidelines; we need to implement them?’” she asks colleagues.Care to women should not depend on where they live or who they turn to for healthcare, Bove adds.

Recommendations on Pregnancy and MS from the American Academy of Neurology

When choosing an MS therapy, keep in mind which must be discontinued before conception, the time it takes the drug to leave your system, agency guidelines and safety information from trials and registries.
Discuss family planning early and frequently with your providers, since in some cases, you must stop using your DMT 6 months before conception and may require extra vaccine checks.
Follow general guidelines regarding folic acid and prenatal supplements as well as recommendations about vitamin D and sleep for people with MS.
Discontinue most DMTs as soon as you confirm you are pregnant, if not sooner.
Make decisions with your healthcare providers.
You can continue having MRIs if needed, but avoid contrast agents.
MS should not affect delivery plans unless you have significant disability.
The type of anesthesia you use depends on obstetric criteria only.
Pay attention to signs of depression.
Consult with your provider about resuming your DMT.

Care for Both Mother and Child

During fertile years, women with MS should regularly discuss whether they plan to get pregnant with the different members of their healthcare team, including their neurologist, OB-GYN and primary care physician, Bove recommends. In addition to making DMT decisions, it is important to have advance conversations about treatments for symptoms, vaccines and plans for delivery and breastfeeding.Along with doing baseline magnetic resonance imaging (MRI), comprehensive pregnancy planning should also include discussions between medical professionals and patients about issues such as genetic risks, smoking and social support needs.Around the seventh month of pregnancy, neurologists should start planning postpartum care with their patients, Bove suggests. Given the rate of MS relapses after delivery, the so-called fourth trimester of pregnancy is critical, she adds.Recommendations for after delivery include MRIs to check for new MS inflammation and screening for vitamin D and thyroid changes. Also, she says, women may need help with issues such as:

Bladder and bowel control
Difficulty walking or holding their babies
Family relations
Fatigue
Lactation issues
Postpartum depression and anxiety
Work

MS care of pregnant women now often goes beyond protecting the infant from unknown risks at all costs, at the expense of the mother, Bove says. If a pregnant woman can stop worrying about relapses, that is also good for her child’s development, she adds.“Maternal well-being is beneficial for the baby, as well as for the family.”

Susana Cummings

Susana Cummings is a senior specialist for bilingual content with the National Multiple Sclerosis Society.

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Is It Safe to Take a DMT While Pregnant?

MS Disease and Pregnancy

MS Activity During and After Pregnancy

From the Lab to Doctors’ Offices

Recommendations on Pregnancy and MS from the American Academy of Neurology

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Care for Both Mother and Child

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