- Does MS affect my fertility?
- Will pregnancy affect the course of my MS?
- Will I be able to breast feed after delivery?
- How long before I fall pregnant must I stop my DMT?
- If I fall pregnant on a DMT will this affect the baby?
- Can I breast feed on my DMT?
- Will I be able to be a good parent if I become disabled from my MS?
- If I become disabled or unemployed as a result of MS will I be able to support my children?
- What is the risk of my children getting MS?
- Can I do anything to prevent them from getting MS?
- Am I more likely to need an assisted delivery because I have MS?
- Will I be able to have a normal vaginal delivery?
- Will I be able to have an epidural during labour?
- How you treat hyperemesis gravidarum during pregnancy?
- Should I continue taking my other drugs for my MS symptoms during pregnancy?
- What is the best treatment strategy for my MS? Should I go onto a DMT and get my MS under control before starting a family or should I first start my family?
- What is the best treatment strategy for my MS to maximise my chances of having a family and keeping my MS under control?
- How will having neutralizing anti-interferon beta antibodies affect my baby?
- Can I have IVF? Will the drugs that are used to induce ovulation affect my MS?
- What dose of vitamin D do you advise during pregnancy?
- Are oral contraceptive safer for my MS? Which contraceptive do you recommend?
Epub: Haghikia et al. Natalizumab Use During the Third Trimester of Pregnancy.JAMA Neurol. 2014. doi: 10.1001/jamaneurol.2014.209.
IMPORTANCE: Natalizumab reduces multiple sclerosis relapses very effectively; however, severe disease activity may return once natalizumab treatment is withdrawn, as recommended during pregnancy. Sometimes restarting natalizumab treatment may be the best option for the mother, but the consequences for the infant are unknown. Except for a few single case reports, to our knowledge, comprehensive data about third-trimester natalizumab exposure are scant.
OBSERVATIONS: In a case series of 12 women with 13 pregnancies and highly active multiple sclerosis who were treated with natalizumab during their third trimester of pregnancy, we assessed the clinical and laboratory effects on the newborns. We observed mild to moderate haematologic alterations in 10 of 13 infants including thrombocytopaenia and anaemia. In a subsample of 5 mother-child pairs, we analyzed natalizumab levels in the umbilical cord blood. Natalizumab was detectable in all 5 newborns.
CONCLUSION AND RELEVANCE: Natalizumab can be a therapeutic option in MSers with highly active multiple sclerosis during pregnancy. We recommend that a paediatrician be available at the time of delivery to evaluate for potential complications of anaemia and thrombocytopaenia in newborns exposed to natalizumab during the third trimester.