Neurol. praxi. 2010;11(6):391-395

Multiple sclerosis and its treatment in pregnancy from the viewpoint of the Czech Teratology Information Service:

MUDr.Lucie Hubičková Heringová, Ph.D., MUDr.Eva Maňáková, Ph.D.

Česká teratologická informační služba, 3. lékařská fakulta, Univerzita Karlova v Praze

assessment of embryotoxicity risk of pharmacotherapy based on previous experience

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system; it commonly affects women of childbearing

age. Due to the chronic nature of the condition, treatment may be required even during pregnancy in some cases. Standard recommendations

are used for MS and its treatment in pregnancy: patients are advised to plan their pregnancy during a stable phase of

their disease when it is possible to discontinue the long-term treatment. If the condition has not stabilized optimally and in the case of

a clinical attack, low doses of corticoids and/or intravenous immunoglobulins are recommended. Treatment with other agents, such as

immunomodulators interferon beta and glatiramer acetate that are first-choice drugs outside of pregnancy, is not recommended during

pregnancy. There are concerns stemming from the lack of information on their risk for the fetus or from a higher risk of miscarriage and

growth retardation of the fetus reported by some studies.

The paper provides an insight into MS and particularly its treatment in pregnancy based on previous experience and results of studies

investigating teratology information services (ENTIS) that are concerned with embryotoxicity risk assessment. According to ENTIS, glatiramer

acetate and interferon beta do not pose a significant risk to the fetus. The results of epidemiological studies suggest that, for

normal fetal development, it is essential to keep the disease in remission, even at the expense of adequate treatment. When selecting

medications, it is important to favor those with a well-known and low risk of embryotoxicity, ideally in monotherapy and at the lowest

dose possible. The pregnancy has to be monitored closely by ultrasound with respect to structural defects and intrauterine growth

retardation. The present review summarizes all available and recent experience with the agents used for the treatment of MS during

pregnancy regarding their embryotoxicity risk.

Information Services (ENTIS), Czech Teratology Information Service (CZTIS).

Keywords: multiple sclerosis, pregnancy, first-choice drugs, teratology counseling, embryotoxicity risk, European Network of Teratology

Published: December 31, 2010  Show citation