Reproductive Health
Women Living With MS
Menstrual Cycle Impact on MS
MS and Contraception
Gynecological Health
Family Planning and Multiple Sclerosis
MS and Conception
Disease-Modifying Therapies and Family Planning
Pregnancy and MS
Graham et al., 2024). All forms of anesthesia are considered safe for women of reproductive potential with MS; anesthesia management does not need to be altered. Epidural anesthesia does not affect the likelihood of postpartum relapse (Bornemann-Cimenti et al., 2017; Makris et al., 2014; Vukusic and Confavreux, 2006). This information should be discussed with the anesthesia team during the early weeks of pregnancy." c-nmssatomrichtext_nmssatomrichtext-host=""> MS should not affect the mode of delivery except in cases of substantial disability. Cesarian sections do not seem to affect relapse rates after labor (Graham et al., 2024). All forms of anesthesia are considered safe for women of reproductive potential with MS; anesthesia management does not need to be altered. Epidural anesthesia does not affect the likelihood of postpartum relapse (Bornemann-Cimenti et al., 2017; Makris et al., 2014; Vukusic and Confavreux, 2006). This information should be discussed with the anesthesia team during the early weeks of pregnancy.Krysko et al., 2020).In recent years, research has demonstrated that most injectables (interferons, glatiramer acetate, ofatumumab) or intravenous monoclonal antibodies (ocrelizumab, rituximab, and probably ublituximab and natalizumab) are safe during breastfeeding once mature milk comes in at 2 weeks postpartum (Graham et al., 2024; Langer-Gould et al., 2020).Monoclonal antibodies are detected at trace levels in milk and are likely to be partially destroyed in the infant’s gastrointestinal tract. Other medications, particularly oral DMTS, are not recommended during breastfeeding as we do not yet know the extent to which they pass into breastmilk.Overall, it is important for women to consider factors like social support, sleep, energy and the baby’s health when deciding whether to breastfed." c-nmssatomrichtext_nmssatomrichtext-host=""> Patients intending to breastfeed for both general benefits to mother and infant and for specific effects on relapse risk reduction, can benefit from support including early referral to lactation experts if needed. In individuals with MS, breastfeeding is associated with 37% lower odds of postpartum relapse compared with those who do not breastfeed. Exclusive breastfeeding has shown even greater benefit with a 48% reduction in odds (Krysko et al., 2020).In recent years, research has demonstrated that most injectables (interferons, glatiramer acetate, ofatumumab) or intravenous monoclonal antibodies (ocrelizumab, rituximab, and probably ublituximab and natalizumab) are safe during breastfeeding once mature milk comes in at 2 weeks postpartum (Graham et al., 2024; Langer-Gould et al., 2020).Monoclonal antibodies are detected at trace levels in milk and are likely to be partially destroyed in the infant’s gastrointestinal tract. Other medications, particularly oral DMTS, are not recommended during breastfeeding as we do not yet know the extent to which they pass into breastmilk.Overall, it is important for women to consider factors like social support, sleep, energy and the baby’s health when deciding whether to breastfed.Anderson et al., 2021; Houtchens et al., 2020). These new lesions correlated with relapses and even occurred in asymptomatic patients. Risk of postpartum inflammatory activity is reduced with: - MS stability before conception (Bove et al., 2014; Confavreux et al., 1998; Coyle, 2016; Vukusic et al., 2004)
- Exclusive breastfeeding (Langer-Gould et al., 2020)
- Initiation of highly effective medications with low therapeutic lag (Roos et al., 2021)
- Mood and fatigue management
- Physical therapy
- Pelvic floor therapy
- MRIs
- Treatment resumption
In the postpartum period there can be a risk of elevated inflammatory activity, both clinical and radiological. Retrospective studies showed that over half of all patients with postpartum MRIs showed new lesions (Anderson et al., 2021; Houtchens et al., 2020). These new lesions correlated with relapses and even occurred in asymptomatic patients. Risk of postpartum inflammatory activity is reduced with:- MS stability before conception (Bove et al., 2014; Confavreux et al., 1998; Coyle, 2016; Vukusic et al., 2004)
- Exclusive breastfeeding (Langer-Gould et al., 2020)
- Initiation of highly effective medications with low therapeutic lag (Roos et al., 2021)
- Mood and fatigue management
- Physical therapy
- Pelvic floor therapy
- MRIs
- Treatment resumption
Boz et al., 2018)." c-nmssatomrichtext_nmssatomrichtext-host=""> Methylprednisolone transfer into breast milk is very low and, therefore, can be used even with breastfeeding 1 hour after infusion. To limit infant exposure still further, individuals can wait 2-4 hours after infusion before resuming breastfeeding (Boz et al., 2018).