Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy

References

• Coyle PK. Management of women with multiple sclerosis through pregnancy and after childbirth. Ther Adv Neurol Disord. 2016;9(3):198–210. doi:10.1177/1756285616631897
   PubMed Web of Science ®Google Scholar
• Harbo HF, Gold R, Tintore M. Sex and gender issues in multiple sclerosis. Ther Adv Neurol Disord. 2013;6(4):237–248. doi:10.1177/1756285613488434
   PubMed Web of Science ®Google Scholar
• Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. Multiple sclerosis. Lancet. 2018;391(10130):1622–1636. doi:10.1016/S0140-6736(18)30481-1
   PubMed Web of Science ®Google Scholar
• Alonso A, Hernán MA. Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology. 2008;71(2):129–135. doi:10.1212/01.wnl.0000316802.35974.34
   PubMed Web of Science ®Google Scholar
• Trojano M, Lucchese G, Graziano G, et al. Geographical variations in sex ratio trends over time in multiple sclerosis. PLoS One. 2012;7(10):e48078. doi:10.1371/journal.pone.0048078
   PubMed Web of Science ®Google Scholar
• Candeliere-Merlicco A, Valero-Delgado F, Martínez-Vidal S, et al. Prevalence of multiple sclerosis in Health District III, Murcia, Spain. Mult Scler Relat Disord. 2016;9:31–35. doi:10.1016/j.msard.2016.06.003
   PubMed Web of Science ®Google Scholar
• Perez-Carmona N, Gimenez-Martinez J, Borrego-Honrubia C, Sempere AP. Multiple sclerosis prevalence and incidence in San Vicente del Raspeig, Spain. Mult Scler Relat Disord. 2019;33:78–81. doi:10.1016/j.msard.2019.05.022
   PubMed Web of Science ®Google Scholar
• Thompson AJ, Banwell BL, Barkhof F, et al. Position paper diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–173. doi:10.1016/S1474-4422(17)30470-2
   PubMed Web of Science ®Google Scholar
• Rasmussen PV, Magyari M, Moberg JY, Bøgelund M, Jensen UFA, Madsen KG. Patient awareness about family planning represents a major knowledge gap in multiple sclerosis. Mult Scler Relat Disord. 2018;24:129–134. doi:10.1016/j.msard.2018.06.006
   PubMed Web of Science ®Google Scholar
• Runmarker B, Andersen O. Pregnancy is associated with a lower risk of onset and a better prognosis in multiple sclerosis. Brain. 1995;118(1):253–261. doi:10.1093/brain/118.1.253
   PubMed Web of Science ®Google Scholar
• Weinshenker BG, Hader W, Carriere W, Baskerville J, Ebers GC. The influence of pregnancy on disability from multiple sclerosis: a population-based study in Middlesex County, Ontario. Neurology. 1989;39(11):1438–1440. doi:10.1212/WNL.39.11.1438
   PubMed Web of Science ®Google Scholar
• Alwan S, Yee I, Dybalski M, et al. Reproductive decision making after the diagnosis of multiple sclerosis (MS). Mult Scler. 2013;19(3):351–358. doi:10.1177/1352458512452920
   PubMed Web of Science ®Google Scholar
• Moberg JY, Laursen B, Thygesen LC, Magyari M. Reproductive history of the Danish multiple sclerosis population: a register-based study. Mult Scler. 2020;26(8):902–911. doi:10.1177/1352458519851245
   PubMed Web of Science ®Google Scholar
• Ferraro D, Simone AM, Adani G, et al. Definitive childlessness in women with multiple sclerosis: a multicenter study. Neurol Sci. 2017;38(8):1453–1459. doi:10.1007/s10072-017-2999-1
   PubMed Web of Science ®Google Scholar
• Houtchens M, Edwards N, Schneider G, Stern K, Phillips AL. Pregnancy rates and outcomes in women with and without MS in the United States. Neurology. 2018;91(17):e1559–e1569. doi:10.1212/WNL.0000000000006384
   PubMed Web of Science ®Google Scholar
• Nguyen AL, Havrdova EK, Horakova D, et al. Incidence of pregnancy and disease-modifying therapy exposure trends in women with multiple sclerosis: a contemporary cohort study. Mult Scler Relat Disord. 2019;28:235–243. doi:10.1016/j.msard.2019.01.003
   PubMed Web of Science ®Google Scholar
• Orton S-M, Herrera BM, Yee IM, et al. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol. 2006;5(11):932–936. doi:10.1016/S1474-4422(06)70581-6
   PubMed Web of Science ®Google Scholar
• Gold SM, Willing A, Leypoldt F, Paul F, Friese MA. Sex differences in autoimmune disorders of the central nervous system. Semin Immunopathol. 2019;41(2):177–188. doi:10.1007/s00281-018-0723-8
   PubMed Web of Science ®Google Scholar
• Sellner J, Kraus J, Awad A, Milo R, Hemmer B, Stüve O. The increasing incidence and prevalence of female multiple sclerosis–a critical analysis of potential environmental factors. Autoimmun Rev. 2011;10(8):495–502. doi:10.1016/j.autrev.2011.02.006
   PubMed Web of Science ®Google Scholar
• Kalincik T, Vivek V, Jokubaitis V, et al. Sex as a determinant of relapse incidence and progressive course of multiple sclerosis. Brain. 2013;136(12):3609–3617. doi:10.1093/brain/awt281
   PubMed Web of Science ®Google Scholar
• Pozzilli C, Tomassini V, Marinelli F, Paolillo A, Gasperini C, Bastianello S. “Gender gap” in multiple sclerosis: magnetic resonance imaging evidence. Eur J Neurol. 2003;10(1):95–97. doi:10.1046/j.1468-1331.2003.00519.x
   PubMed Web of Science ®Google Scholar
• Weinshenker BG, Rice GP, Noseworthy JH, Carriere W, Baskerville J, Ebers GC. The natural history of multiple sclerosis: a geographically based study. 3. Multivariate analysis of predictive factors and models of outcome. Brain. 1991;114(Pt2):1045–1056. doi:10.1093/brain/114.2.1045
   PubMed Web of Science ®Google Scholar
• Confavreux C, Vukusic S, Adeleine P. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain. 2003;126(4):770–782. doi:10.1093/brain/awg081
   PubMed Web of Science ®Google Scholar
• Tremlett H, Zhao Y, Rieckmann P, Hutchinson M. New perspectives in the natural history of multiple sclerosis. Neurology. 2010;74(24):2004–2015. doi:10.1212/WNL.0b013e3181e3973f
   PubMed Web of Science ®Google Scholar
• Schoonheim MM, Popescu V, Rueda Lopes FC, et al. Subcortical atrophy and cognition: sex effects in multiple sclerosis. Neurology. 2012;79(17):1754–1761. doi:10.1212/WNL.0b013e3182703f46
   PubMed Web of Science ®Google Scholar
• Koch M, Kingwell E, Rieckmann P, et al. The natural history of secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry. 2010;81(9):1039–1043. doi:10.1136/jnnp.2010.208173
   PubMed Web of Science ®Google Scholar
• Voskuhl RR, Gold SM. Sex-related factors in multiple sclerosis susceptibility and progression. Nat Rev Neurol. 2012;8(5):255–263. doi:10.1038/nrneurol.2012.43
   PubMed Web of Science ®Google Scholar
• Airas L. Hormonal and gender-related immune changes in multiple sclerosis. Acta Neurol Scand. 2015;132(199):62–70. doi:10.1111/ane.12433
   PubMed Web of Science ®Google Scholar
• Bove RM, Healy B, Augustine A, Musallam A, Gholipour T, Chitnis T. Effect of gender on late-onset multiple sclerosis. Mult Scler. 2012;18(10):1472–1479. doi:10.1177/1352458512438236
   PubMed Web of Science ®Google Scholar
• Alonso A, Jick SS, Olek MJ, Ascherio A, Jick H, Hernan MA. Recent use of oral contraceptives and the risk of multiple sclerosis. Arch Neurol. 2005;62(9):1362–1365. doi:10.1001/archneur.62.9.1362
   PubMedGoogle Scholar
• Nelson LM, Franklin GM, Jones MC. Risk of multiple sclerosis exacerbation during pregnancy and breast-feeding. JAMA. 1988;259(23):3441–3443. doi:10.1001/jama.1988.03720230051029
   PubMed Web of Science ®Google Scholar
• Bernardi S, Grasso M, Bertollini R, Orzi F, Fieschi C. The influence of pregnancy on relapses in multiple sclerosis: a cohort study. Acta Neurol Scand. 1991;84(5):403–406. doi:10.1111/j.1600-0404.1991.tb04977.x
   PubMed Web of Science ®Google Scholar
• Villard-Mackintosh L, Vessey MP. Oral contraceptives and reproductive factors in multiple sclerosis incidence. Contraception. 1993;47(2):161–168. doi:10.1016/0010-7824(93)90088-O
   PubMed Web of Science ®Google Scholar
• Hernán MA, Hohol MJ, Olek MJ, Spiegelman D, Ascherio A. Oral contraceptives and the incidence of multiple sclerosis. Neurology. 2000;55(6):848–854. doi:10.1212/WNL.55.6.848
   PubMed Web of Science ®Google Scholar
• Thorogood M, Hannaford PC. The influence of oral contraceptives on the risk of multiple sclerosis. Br J Obstet Gynaecol. 1998;105(12):1296–1299. doi:10.1111/j.1471-0528.1998.tb10008.x
   PubMedGoogle Scholar
• Langer-Gould A, Smith JB, Hellwig K, et al. Breastfeeding, ovulatory years, and risk of multiple sclerosis. Neurology. 2017;89(6):563–569. doi:10.1212/WNL.0000000000004207
   PubMed Web of Science ®Google Scholar
• Magyari M. Role of socio-economic and reproductive factors in the risk of multiple sclerosis. Acta Neurol Scand. 2015;132(199):20–23. doi:10.1111/ane.12426
   PubMed Web of Science ®Google Scholar
• Ponsonby A, Lucas R, van der Mei I, et al. Offspring number, pregnancy, and risk of a first clinical demyelinating event: the AusImmune Study. Neurology. 2012;78(12):867–874. doi:10.1212/WNL.0b013e31824c4648
   PubMed Web of Science ®Google Scholar
• Nguyen AL, Vodehnalova K, Kalincik T, et al. Association of pregnancy with the onset of clinically isolated syndrome. JAMA Neurol. 2020;77(12):1496–1503. doi:10.1001/jamaneurol.2020.3324
   PubMed Web of Science ®Google Scholar
• Krysko K, Graves JS, Dobson R, et al. Sex effects across the lifespan in women with multiple sclerosis. Ther Adv Neurol Disord. 2020;13:1756286420936166. doi:10.1177/1756286420936166
   Web of Science ®Google Scholar
• Wijnands JMA, Kingwell E, Zhu F, et al. Health-care use before a first demyelinating event suggestive of a multiple sclerosis prodrome: a matched cohort study. Lancet Neurol. 2017;16(6):445–451. doi:10.1016/S1474-4422(17)30076-5
   PubMed Web of Science ®Google Scholar
• Lebrun C, Cohen M, Chaussenot A, Mondot L, Chanalet S. A prospective study of patients with brain MRI showing incidental t2 hyperintensities addressed as multiple sclerosis: a lot of work to do before treating. Neurol Ther. 2014;3(2):123–132. doi:10.1007/s40120-014-0024-7
   PubMedGoogle Scholar
• Grinsted L, Heltberg A, Hagen C, Djursing H. Serum sex hormone and gonadotropin concentrations in premenopausal women with multiple sclerosis. J Int Med. 1989;226(4):241–244. doi:10.1111/j.1365-2796.1989.tb01387.x
   PubMed Web of Science ®Google Scholar
• Thone J, Kollar S, Nousome D, et al. Serum anti-Mullerian hormone levels in reproductive-age women with relapsing-remitting multiple sclerosis. Mult Scler. 2014;21(1):41–47. doi:10.1177/1352458514540843
   PubMed Web of Science ®Google Scholar
• Sepúlveda M, Ros C, Martínez-Lapiscina EH, et al. Pituitary-ovary axis and ovarian reserve in fertile women with multiple sclerosis: a pilot study. Mult Scler. 2016;22(4):564–568. doi:10.1177/1352458515602339
   PubMed Web of Science ®Google Scholar
• Amato MP, Portaccio E. Fertility, pregnancy and childbirth in patients with multiple sclerosis: impact of disease-modifying drugs. CNS Drugs. 2015;29(3):207–220. doi:10.1007/s40263-015-0238-y
   PubMed Web of Science ®Google Scholar
• Hellwig K. Pregnancy in multiple sclerosis. Eur Neurol. 2014;72(Suppl 1):39–42. doi:10.1159/000367640
   PubMed Web of Science ®Google Scholar
• Hellwig K, Correale J. Artificial reproductive techniques in multiple sclerosis. Clin Immunol. 2013;149(2):219–224. doi:10.1016/j.clim.2013.02.001
   PubMed Web of Science ®Google Scholar
• Roux T, Courtillot C, Debs R, Touraine P, Lubetzki C, Papeix C. Fecundity in women with multiple sclerosis: an observational mono-centric study. J Neurol. 2015;262(4):957–960. doi:10.1007/s00415-015-7663-1
   PubMed Web of Science ®Google Scholar
• Soler B, Ciampi E, Uribe-San-Martín R, et al. Pregnancy outcomes in women with multiple sclerosis. Mult Scler Relat Disord. 2021;48:102682. doi:10.1016/j.msard.2020.102682
   PubMed Web of Science ®Google Scholar
• Chen YH, Lin HL, Lin HC. Does multiple sclerosis increase risk of adverse pregnancy outcomes? A population-based study. Mult Scler. 2009;15(5):606–612. doi:10.1177/1352458508101937
   PubMed Web of Science ®Google Scholar
• Bodiguel E, Bensa C, Brassat D, et al. Multiple sclerosis and pregnancy. Rev Neurol (Paris). 2014;170(4):247–265. doi:10.1016/j.neurol.2013.09.010
   PubMed Web of Science ®Google Scholar
• MacDonald SC, McElrath TF, Hernández-Díaz S. Pregnancy outcomes in women with multiple sclerosis. Am J Epidemiol. 2019;188(1):57–66. doi:10.1093/aje/kwy197
   PubMed Web of Science ®Google Scholar
• Bove R, Alwan S, Friedman JM, et al. Management of multiple sclerosis during pregnancy and the reproductive years. Obstet Gynecol. 2014;124(6):1157–1168. doi:10.1097/AOG.0000000000000541
   PubMed Web of Science ®Google Scholar
• van der Kop ML, Pearce MS, Dahlgren L, et al. Neonatal and delivery outcomes in women with multiple sclerosis. Ann Neurol. 2011;70(1):41–50. doi:10.1002/ana.22483
   PubMed Web of Science ®Google Scholar
• Jalkanen A, Alanen A, Airas L; Finnish Multiple Sclerosis and Pregnancy Study Group. Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland. Mult Scler. 2010;16(8):950–955. doi:10.1177/1352458510372629
   PubMed Web of Science ®Google Scholar
• Amato MP, Bertolotto A, Brunelli R, et al. Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach. Neurol Sci. 2017;38(10):1849–1858. doi:10.1007/s10072-017-3081-8
   PubMed Web of Science ®Google Scholar
• MacDonald SC, McElrath TF, Hernández-Díaz S. Use and safety of disease-modifying therapy in pregnant women with multiple sclerosis. Pharmacoepidemiol Drug Saf. 2019;28(4):556–560. doi:10.1002/pds.4735
   PubMed Web of Science ®Google Scholar
• Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998;339(5):285–291. doi:10.1056/NEJM199807303390501
   PubMed Web of Science ®Google Scholar
• Vukusic S, Confavreux C. Pregnancy and multiple sclerosis: the children of PRIMS. Clin Neurol Neurosurg. 2006;108(3):266–270. doi:10.1016/j.clineuro.2005.11.016
   PubMed Web of Science ®Google Scholar
• Vukusic S, Marignier R. Multiple sclerosis and pregnancy in the “treatment era.”. Nat Rev Neurol. 2015;11(5):280–289. doi:10.1038/nrneurol.2015.53
   PubMed Web of Science ®Google Scholar
• Fernandez Liguori N, Klajn D, Acion L, et al. Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study). Mult Scler. 2009;15(5):555–562. doi:10.1177/1352458509102366
   PubMed Web of Science ®Google Scholar
• Finkelsztejn A, Fragoso Y, Ferreira ML, et al. The Brazilian database on pregnancy in multiple sclerosis. Clin Neurol Neurosurg. 2011;113:277–280. doi:10.1016/j.clineuro.2010.11.016
   PubMed Web of Science ®Google Scholar
• Hellwig K, Haghikia A, Rockhoff M, Gold R. Multiple sclerosis and pregnancy: experience from a nationwide database in Germany. Ther Adv Neurol Disord. 2012;5(5):247–253. doi:10.1177/1756285612453192
   PubMed Web of Science ®Google Scholar
• Jesus-Ribeiro J, Correia I, Martins AI, et al. Pregnancy in multiple sclerosis: a Portuguese cohort study. Mult Scler Relat Disord. 2017;17:63–68. doi:10.1016/j.msard.2017.07.002
   PubMed Web of Science ®Google Scholar
• Dobson R, Jokubaitis VG, Giovannoni G. Change in pregnancy-associated multiple sclerosis relapse rates over time: a meta-analysis. Mult Scler Relat Disord. 2020;44:102241. doi:10.1016/j.msard.2020.102241
   PubMed Web of Science ®Google Scholar
• Finkelsztejn A, Brooks JBB, Paschoal FM, Fragoso YD. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature. BJOG. 2011;118(7):790–797. doi:10.1111/j.1471-0528.2011.02931.x
   PubMed Web of Science ®Google Scholar
• Modrego PJ, Urrea MA, de Cerio LD. The effects of pregnancy on relapse rates, disability and peripartum outcomes in women with multiple sclerosis: a systematic review and meta-analysis. J Comp Eff Res. 2021;10(3):175–186. doi:10.2217/cer-2020-0211
   PubMed Web of Science ®Google Scholar
• Paavilainen T, Kurki T, Parkkola R, et al. Magnetic resonance imaging of the brain used to detect early post-partum activation of multiple sclerosis. Eur J Neurol. 2007;14(11):1216–1221. doi:10.1111/j.1468-1331.2007.01927.x
   PubMed Web of Science ®Google Scholar
• van Walderveen MA, Tas MW, Barkhof F, et al. Magnetic resonance evaluation of disease activity during pregnancy in multiple sclerosis. Neurology. 1994;44(2):327–329. doi:10.1212/WNL.44.2.327
   PubMed Web of Science ®Google Scholar
• Saraste MH, Kurki T, Airas LM. Postpartum activation of multiple sclerosis: MRI imaging and immunological characterization of a case. Eur J Neurol. 2006;13(1):98–99. doi:10.1111/j.1468-1331.2006.01108.x
   PubMed Web of Science ®Google Scholar
• Fabian M. Pregnancy in the setting of multiple sclerosis. Continuum (Minneap Minn). 2016;22(3):837–850. doi:10.1212/CON.0000000000000328
   PubMedGoogle Scholar
• Patas K, Engler JB, Friese MA, Gold SM. Pregnancy and multiple sclerosis: feto-maternal immune cross talk and its implications for disease activity. J Reprod Immunol. 2013;97(1):140–146. doi:10.1016/j.jri.2012.10.005
   PubMed Web of Science ®Google Scholar
• Bouman A, Heineman MJ, Faas MM. Sex hormones and the immune response in humans. Hum Reprod Update. 2005;11(4):411–423. doi:10.1093/humupd/dmi008
   PubMed Web of Science ®Google Scholar
• Phiel KL, Henderson RA, Adelman SJ, Elloso MM. Differential estrogen receptor gene expression in human peripheral blood mononuclear cell populations. Immunol Lett. 2005;97(1):107–113. doi:10.1016/j.imlet.2004.10.007
   PubMed Web of Science ®Google Scholar
• Robinson DP, Klein SL. Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Horm Behav. 2012;62(3):263–271. doi:10.1016/j.yhbeh.2012.02.023
   PubMed Web of Science ®Google Scholar
• Airas L, Saraste M, Rinta S, et al. Immunoregulatory factors in multiple sclerosis patients during and after pregnancy: relevance of natural killer cells. Clin Exp Immunol. 2008;151(2):235–243. doi:10.1111/j.1365-2249.2007.03555.x
   PubMed Web of Science ®Google Scholar
• de Andrés C, Fernández-Paredes L, Tejera-Alhambra M, Alonso B, Ramos-Medina R, Sánchez-Ramón S. Activation of blood CD3+CD56+CD8+ T cells during pregnancy and multiple sclerosis. Front Immunol. 2017;8:196. doi:10.3389/fimmu.2017.00196
   PubMed Web of Science ®Google Scholar
• Neuteboom RF, Verbraak E, Wierenga-Wolf AF, et al. The monocyte transcriptome during pregnancy in multiple sclerosis: prominent expression of the Fc-receptor CD64. Mult Scler. 2011;17(4):389–396. doi:10.1177/1352458510389628
   PubMed Web of Science ®Google Scholar
• Sánchez-Ramón S, Navarro AJ, Aristimuño C, et al. Pregnancy-induced expansion of regulatory T-lymphocytes may mediate protection to multiple sclerosis activity. Immunol Lett. 2005;96(2):195–201. doi:10.1016/j.imlet.2004.09.004
   PubMed Web of Science ®Google Scholar
• Schumacher M, Mattern C, Ghoumari A, et al. Revisiting the roles of progesterone and allopregnanolone in the nervous system: resurgence of the progesterone receptors. Prog Neurobiol. 2014;113:6–39. doi:10.1016/j.pneurobio.2013.09.004
   PubMed Web of Science ®Google Scholar
• El-Etr M, Rame M, Boucher C, et al. Progesterone and nestorone promote myelin regeneration in chronic demyelinating lesions of corpus callosum and cerebral cortex. Glia. 2015;63(1):104–117. doi:10.1002/glia.22736
   PubMed Web of Science ®Google Scholar
• Benoit A, Durand-Dubief F, Amato MP, et al. History of multiple sclerosis in 2 successive pregnancies. A French and Italian cohort. Neurology. 2016;87:1360–1367. doi:10.1212/WNL.0000000000003036
   PubMed Web of Science ®Google Scholar
• Hellwig K, Brune N, Haghikia A, et al. Reproductive counselling, treatment and course of pregnancy in 73 German MS patients. Acta Neurol Scand. 2008;118(1):24–28. doi:10.1111/j.1600-0404.2007.00978.x
   PubMed Web of Science ®Google Scholar
• Herbstritt S, Langer-Gould A, Rockhoff M, et al. Glatiramer acetate during early pregnancy: a prospective cohort study. Mult Scler. 2016;22(6):810–816. doi:10.1177/1352458515623366
   PubMed Web of Science ®Google Scholar
• Saraste M, Väisänen S, Alanen A, Airas L; Finnish Multiple Sclerosis and Pregnancy Study Group. Clinical and immunologic evaluation of women with multiple sclerosis during and after pregnancy. Gend Med. 2007;4(1):45–55. doi:10.1016/S1550-8579(07)80008-8
   PubMedGoogle Scholar
• Vukusic S, Hutchinson M, Hours M, et al. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain. 2004;127(6):1353–1360. doi:10.1093/brain/awh152
   PubMed Web of Science ®Google Scholar
• Bsteh G, Algrang L, Hegen H, et al. Pregnancy and multiple sclerosis in the DMT era: a cohort study in Western Austria. Mult Scler. 2020;26(1):69–78. doi:10.1177/1352458518816614
   PubMed Web of Science ®Google Scholar
• Thiel S, Langer-Gould A, Rockhoff M, et al. Interferon-beta exposure during first trimester is safe in women with multiple sclerosis-A prospective cohort study from the German Multiple Sclerosis and Pregnancy Registry. Mult Scler. 2016;22(6):801–809. doi:10.1177/1352458516634872
   PubMed Web of Science ®Google Scholar
• Yeh WZ, Widyastuti PA, van der Walt A, et al. Natalizumab, fingolimod and dimethyl fumarate use and pregnancy-related relapse and disability in women with multiple sclerosis. Neurology. 2021;96(24):e2989–e3002. doi:10.1212/WNL.0000000000012084
   PubMed Web of Science ®Google Scholar
• Alroughani R, Akhtar S, Zeineddine M, et al. Risk of relapses during pregnancy among multiple sclerosis patients. Mult Scler Relat Disord. 2019;34:9–13. doi:10.1016/j.msard.2019.06.007
   PubMed Web of Science ®Google Scholar
• Villaverde-González R, Candeliere-Merlicco A, Alonso-Frías MA, et al. Discontinuation of disease-modifying treatments in multiple sclerosis to plan a pregnancy: a retrospective registry study. Mult Scler Relat Disord. 2020;46:102518. doi:10.1016/j.msard.2020.102518
   PubMed Web of Science ®Google Scholar
• Airas L, Jalkanen A, Alanen A, Pirttilä T, Marttila RJ. Breast-feeding, postpartum and prepregnancy disease activity in multiple sclerosis. Neurology. 2010;75(5):474–476. doi:10.1212/WNL.0b013e3181eb5860
   PubMed Web of Science ®Google Scholar
• Langer-Gould A, Smith JB, Albers KB, et al. Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort. Neurology. 2020;94(18):e1939–e1949. doi:10.1212/WNL.0000000000009374
   PubMed Web of Science ®Google Scholar
• Roullet E, Verdier-Taillefer MH, Amarenco P, Gharbi G, Alperovitch A, Marteau R. Pregnancy and multiple sclerosis: a longitudinal study of 125 remittent patients. J Neurol Neurosurg Psychiatry. 1993;56(10):1062–1065. doi:10.1136/jnnp.56.10.1062
   PubMed Web of Science ®Google Scholar
• Worthington J, Jones R, Crawford M, Forti A. Pregnancy and multiple sclerosis–a 3-year prospective study. J Neurol. 1994;241(4):228–233. doi:10.1007/BF00863773
   PubMed Web of Science ®Google Scholar
• Pastò L, Portaccio E, Ghezzi A, et al. Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study. BMC Neurol. 2012;12:165. doi:10.1186/1471-2377-12-165
   PubMed Web of Science ®Google Scholar
• Portaccio E, Ghezzi A, Hakiki B, et al. Breastfeeding is not related to postpartum relapses in multiple sclerosis. Neurology. 2011;77(2):145–150. doi:10.1212/WNL.0b013e318224afc9
   PubMed Web of Science ®Google Scholar
• Hughes SE, Spelman T, Gray OM, et al. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult Scler. 2014;20(6):739–746. doi:10.1177/1352458513507816
   PubMed Web of Science ®Google Scholar
• Hellwig K, Rockhoff M, Herbstritt S, et al. Exclusive breastfeeding and the effect on postpartum multiple sclerosis relapses. JAMA Neurol. 2015;72(10):1132–1138. doi:10.1001/jamaneurol.2015.1806
   PubMed Web of Science ®Google Scholar
• Koch M, Uyttenboogaart M, Heersema D, Steen C, de Keyser J. Parity and secondary progression in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009;80(6):676–678. doi:10.1136/jnnp.2008.160911
   PubMed Web of Science ®Google Scholar
• Karp I, Manganas A, Sylvestre MP, Ho A, Roger E, Duquette P. Does pregnancy alter the long-term course of multiple sclerosis? Ann Epidemiol. 2014;24(7):504–508.e2. doi:10.1016/j.annepidem.2014.04.007
   PubMed Web of Science ®Google Scholar
• D’Hooghe MB, Nagels G, Uitdehaag BMJ. Long-term effects of childbirth in MS. J Neurol Neurosurg Psychiatry. 2010;81(1):38–41. doi:10.1136/jnnp.2008.163816
   PubMed Web of Science ®Google Scholar
• Masera S, Cavalla P, Prosperini L, et al. Parity is associated with a longer time to reach irreversible disability milestones in women with multiple sclerosis. Mult Scler. 2015;21(10):1291–1297. doi:10.1177/1352458514561907
   PubMed Web of Science ®Google Scholar
• Zeydan B, Atkinson EJ, Weis DM, et al. Reproductive history and progressive multiple sclerosis risk in women. Brain Commun. 2020;2(2):fcaa185. doi:10.1093/braincomms/fcaa185
   PubMedGoogle Scholar
• Munger KL, Åivo J, Hongell K, et al. Vitamin D status during pregnancy and risk of multiple sclerosis in offspring of women in the Finnish Maternity Cohort. JAMA Neurol. 2016;73(5):515–519. doi:10.1001/jamaneurol.2015.4800
   PubMed Web of Science ®Google Scholar
• Mirzaei F, Michels KB, Munger K, et al. Gestational vitamin D and the risk of multiple sclerosis in offspring. Ann Neurol. 2011;70(1):30–40. doi:10.1002/ana.22456
   PubMed Web of Science ®Google Scholar
• Drug and Therapeutic Bulletin. Vitamin supplementation in pregnancy. Drug Ther Bull. 2016;54(7):81–84. doi:10.1136/dtb.2016.7.0414
   PubMedGoogle Scholar
• Coyle PK, Oh J, Magyari M, Oreja-Guevara C, Houtchens M. Management strategies for female patients of reproductive potential with multiple sclerosis: an evidence-based review. Mult Scler Relat Disord. 2019;32:54–63. doi:10.1016/j.msard.2019.04.003
   PubMed Web of Science ®Google Scholar
• Seier M, Hiller A. Parkinson’s disease and pregnancy: an updated review. Parkinsonism Relat Disord. 2017;40:11–17. doi:10.1016/j.parkreldis.2017.05.007
   PubMed Web of Science ®Google Scholar
• Baclofen and pregnancy: birth defects and withdrawal symptoms. Prescrire Int. 2015;24(163):214.
   PubMedGoogle Scholar
• Tandon SS, Hoskins I, Azhar S. Intrathecal baclofen pump - a viable therapeutic option in pregnancy. Obstet Med. 2010;3(3):119–120. doi:10.1258/om.2010.100016
   PubMedGoogle Scholar
• Maillart E, Gout O, Lubetzki C, Carpentier B, Nizard J. Favorable outcome of a pregnancy after fampridine exposition during the first month. J Neurol Sci. 2016;370:158. doi:10.1016/j.jns.2016.09.033
   PubMed Web of Science ®Google Scholar
• Cuello JP, Martínez Ginés ML, Martin Barriga ML, de Andrés C. Multiple sclerosis and pregnancy: a single-centre prospective comparative study. Neurologia. 2017;32(2):92–98. doi:10.1016/j.nrl.2014.12.015
   PubMed Web of Science ®Google Scholar
• Mahlanza TD, Manieri MC, Klawiter EC, et al. Prospective growth and developmental outcomes in infants born to mothers with multiple sclerosis. Mult Scler. 2021;27(1):79–89. doi:10.1177/1352458520904545
   PubMed Web of Science ®Google Scholar
• Laplaud D-A, Leray E, Barriere P, Wiertlewski S, Moreau T. Increase in multiple sclerosis relapse rate following in vitro fertilization. Neurology. 2006;66(8):1280–1281. doi:10.1212/01.wnl.0000208521.10685.a6
   PubMed Web of Science ®Google Scholar
• Hellwig K, Beste C, Brune N, et al. Increased MS relapse rate during assisted reproduction technique. J Neurol. 2008;255(4):592–593. doi:10.1007/s00415-008-0607-2
   PubMed Web of Science ®Google Scholar
• Michel L, Foucher Y, Vukusic S, et al. Increased risk of multiple sclerosis relapse after in vitro fertilisation. J Neurol Neurosurg Psychiatry. 2012;83(8):796–802. doi:10.1136/jnnp-2012-302235
   PubMed Web of Science ®Google Scholar
• Correale J, Farez MF, Ysrraelit MC. Increase in multiple sclerosis activity after assisted reproduction technology. Ann Neurol. 2012;72(5):682–694. doi:10.1002/ana.23745
   PubMed Web of Science ®Google Scholar
• Bove R, Rankin K, Lin C, et al. Effect of assisted reproductive technology on multiple sclerosis relapses: case series and meta-analysis. Mult Scler. 2020;26(11):1410–1419. doi:10.1177/1352458519865118
   PubMed Web of Science ®Google Scholar
• Brzosko B, Thiel S, Gold R, Hellwig K. Low relapse risk under disease modifying treatment during ART in women with relapsing remitting multiple sclerosis. Neurology. 2018;90(15 Supplement):P4.356.
   Google Scholar
• Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis. Neurology. 2018;90(17):777–788. doi:10.1212/WNL.0000000000005347
   PubMed Web of Science ®Google Scholar
• Giovannoni G, Butzkueven H, Dhib-Jalbut S, et al. Brain health: time matters in multiple sclerosis. Mult Scler Relat Disord. 2016;9:S5–S48. doi:10.1016/j.msard.2016.07.003
   PubMed Web of Science ®Google Scholar
• Dargahi N, Katsara M, Tselios T, et al. Multiple sclerosis: immunopathology and treatment update. Brain Sci. 2017;7(7):78. doi:10.3390/brainsci7070078
   PubMed Web of Science ®Google Scholar
• Fragoso Y, Boggild M, Macias-Islas MA, et al. The effects of long-term exposure to disease-modifying drugs during pregnancy in multiple sclerosis. Clin Neurol Neurosurg. 2013;115:154–159. doi:10.1016/j.clineuro.2012.04.024
   PubMed Web of Science ®Google Scholar
• Alroughani R, Inshasi J, Al-Asmi A, et al. Disease-modifying drugs and family planning in people with multiple sclerosis: a consensus narrative review from the Gulf Region. Neurol Ther. 2020;9(2):265–280. doi:10.1007/s40120-020-00201-8
   PubMed Web of Science ®Google Scholar
• Canibaño B, Deleu D, Mesraoua B, Melikyan G, Ibrahim F, Hanssens Y. Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations. J Drug Asses. 2020;9(1):20–36. doi:10.1080/21556660.2020.1721507
   PubMed Web of Science ®Google Scholar
• Houtchens MK, Zapata LB, Curtis KM, Whiteman MK. Contraception for women with multiple sclerosis: guidance for healthcare providers. Mult Scler. 2017;23(6):757–764. doi:10.1177/1352458517701314
   PubMed Web of Science ®Google Scholar
• Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends and outcomes. Stud Fam Plann. 2010;41(4):241–250. doi:10.1111/j.1728-4465.2010.00250.x
   PubMed Web of Science ®Google Scholar
• Rasch V. Contraceptive failure–results from a study conducted among women with accepted and unaccepted pregnancies in Denmark. Contraception. 2002;66(2):109–116. doi:10.1016/S0010-7824(02)00325-6
   PubMed Web of Science ®Google Scholar
• Hakkarainen K, Juuti R, Burkill S, et al. Pregnancy outcomes after exposure to interferon beta: a register-based cohort study among women with MS in Finland and Sweden. Ther Adv Neurol Disord. 2020;13:1756286420951072.
   Web of Science ®Google Scholar
• Hellwig K, Geissbuehler Y, Sabidó M, et al. Pregnancy outcomes in interferon-beta-exposed patients with multiple sclerosis: results from the European Interferon-beta Pregnancy Registry. J Neurol. 2020;267(6):1715–1723. doi:10.1007/s00415-020-09762-y
   PubMed Web of Science ®Google Scholar
• Sandberg-Wollheim M, Alteri E, Moraga M, Kornmann G. Pregnancy outcomes in multiple sclerosis following subcutaneous interferon beta-1a therapy. Mult Scler. 2011;17(4):423–430. doi:10.1177/1352458510394610
   PubMed Web of Science ®Google Scholar
• Tomczyk S, Sperling B. Post-marketing pregnancy outcomes in patients exposed to intramuscular interferon-β-1a. Neurology. 2013;80(Meeting Abstracts 1):S30.006.
   Google Scholar
• Coyle PK, Sinclair SM, Scheuerle AE, Thorp JM, Albano JD, Rametta MJ. Final results from the Betaseron (interferon β-1b) pregnancy registry: a prospective observational study of birth defects and pregnancy-related adverse events. BMJ Open. 2014;4(5):e004536. doi:10.1136/bmjopen-2013-004536
   PubMed Web of Science ®Google Scholar
• Amato MP, Portaccio E, Ghezzi A, et al. Pregnancy and fetal outcomes after interferon-β exposure in multiple sclerosis. Neurology. 2010;75(20):1794–1802. doi:10.1212/WNL.0b013e3181fd62bb
   PubMed Web of Science ®Google Scholar
• Boskovic R, Wide R, Wolpin J, Bauer DJ, Koren G. The reproductive effects of beta interferon therapy in pregnancy: a longitudinal cohort. Neurology. 2005;65(6):807–811. doi:10.1212/01.wnl.0000180575.77021.c4
   PubMed Web of Science ®Google Scholar
• Lu E, Wang BW, Guimond C, Synnes A, Sadovnick D, Tremlett H. Disease-modifying drugs for multiple sclerosis in pregnancy; A systematic review. Neurology. 2012;79(11):1130–1135. doi:10.1212/WNL.0b013e3182698c64
   PubMed Web of Science ®Google Scholar
• Weber-Schoendorfer C, Schaefer C. Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study. Mult Scler. 2009;15(9):1037–1042. doi:10.1177/1352458509106543
   PubMed Web of Science ®Google Scholar
• Patti F, Cavallaro T, Lo Fermo S, et al. Is in utero early-exposure to interferon beta a risk factor for pregnancy outcomes in multiple sclerosis? J Neurol. 2008;255(8):1250–1253. doi:10.1007/s00415-008-0909-4
   PubMed Web of Science ®Google Scholar
• Romero RS, Lünzmann C, Bugge J-P. Pregnancy outcomes in patients exposed to interferon beta-1b. J Neurol Neurosurg Psychiatry. 2015;86(5):587–589. doi:10.1136/jnnp-2014-308113
   PubMed Web of Science ®Google Scholar
• Giannini M, Portaccio E, Ghezzi A, et al. Pregnancy and fetal outcomes after Glatiramer Acetate exposure in patients with multiple sclerosis: a prospective observational multicentric study. BMC Neurol. 2012;12:124. doi:10.1001/jamaneurol.2019.4173
   PubMed Web of Science ®Google Scholar
• Sandberg-Wollheim M, Neudorfer O, Grinspan A, et al. Pregnancy outcomes from the Branded glatiramer acetate pregnancy database. Int J MS Care. 2018;20(1):9–14. doi:10.7224/1537-2073.2016-079
   PubMedGoogle Scholar
• Fragoso YD, Finkelsztejn A, Comini-Frota ER, et al. Pregnancy and multiple sclerosis: the initial results from a Brazilian database. Arq Neuropsiquiatr. 2009;67(3A):657–660. doi:10.1590/S0004-282X2009000400015
   PubMed Web of Science ®Google Scholar
• Fragoso YD, Finkelsztejn A, Kaimen-Maciel DR, et al. Long-term use of glatiramer acetate by 11 pregnant women with multiple sclerosis. CNS Drugs. 2010;24(11):969–976. doi:10.2165/11538960-000000000-00000
   PubMed Web of Science ®Google Scholar
• Salminen HJ, Leggett H, Boggild M. Glatiramer acetate exposure in pregnancy: preliminary safety and birth outcomes. J Neurol. 2010;257(12):2020–2023. doi:10.1007/s00415-010-5652-y
   PubMed Web of Science ®Google Scholar
• Dung AAD, Panda AK. Interferon beta-1a therapy for multiple sclerosis during pregnancy: an unresolved issue. BMJ Case Rep. 2014;2014:bcr2013201273. doi:10.1136/bcr-2013-201273
   PubMedGoogle Scholar
• Hellwig K, Gold R. Glatiramer acetate and interferon-beta throughout gestation and postpartum in women with multiple sclerosis. J Neurol. 2011;258(3):502–503. doi:10.1007/s00415-010-5758-2
   PubMed Web of Science ®Google Scholar
• Gold R, Giovannoni G, Phillips JT, et al. Efficacy and safety of delayed-release dimethyl fumarate in patients newly diagnosed with relapsing–remitting multiple sclerosis (RRMS). Mult Scler. 2015;21(1):57–66. doi:10.1177/1352458514537013
   PubMed Web of Science ®Google Scholar
• Hellwig K, Rog D, McGuigan C, Chen K, Parks B, Jones C An international registry tracking pregnancy outcomes in women treated with dimethyl fumarate. Abstract (P1147) at the ECTRIMS 2019 congress; September 11–13, 2019; Stockholm, Sweden. Available from: https://onlinelibrary.ectrims-congress.eu/. Accessed December 22, 2021.
   Google Scholar
• Vaughn C, Bushra A, Kolb C, Weinstock-Guttman B. An update on the use of disease-modifying therapy in pregnant patients with multiple sclerosis. CNS Drugs. 2018;32(2):161–178. doi:10.1007/s40263-018-0496-6
   PubMed Web of Science ®Google Scholar
• The European Medicines Agency - EMA. Tecfidera. Summary of product characteristics. (Online). Available from: https://www.ema.europa.eu/en/documents/product-information/tecfidera-epar-product-information_en.pdf. Accessed August 2, 2021.
   Google Scholar
• The European Medicines Agency - EMA. Mayzent. Summary of product characteristics. (Online). Available from: https://www.ema.europa.eu/en/documents/product-information/mayzent-epar-product-information_en.pdf. Accessed August 2, 2021.
   Google Scholar
• The European Medicines Agency - EMA. Gilenya. Summary of product characteristics. (Online). Available from: https://www.ema.europa.eu/en/documents/product-information/gilenya-epar-product-information_es.pdf. Accessed August 2, 2021.
   Google Scholar
• Koren G, Ornoy A. The role of the placenta in drug transport and fetal drug exposure. Expert Rev Clin Pharmacol. 2018;11(4):373–385. doi:10.1080/17512433.2018.1425615
   PubMed Web of Science ®Google Scholar
• Demortiere S, Rico A, Maarouf A, Boutiere C, Pelletier J, Audoin B. Maintenance of natalizumab during the first trimester of pregnancy in active multiple sclerosis. Mult Scler. 2021;27(5):712–718. doi:10.1177/1352458520912637
   PubMed Web of Science ®Google Scholar
• Portaccio E, Moiola L, Martinelli V, et al. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab II: maternal risks. Neurology. 2018;90(10):e832–e839. doi:10.1212/WNL.0000000000005068
   PubMed Web of Science ®Google Scholar
• Portaccio E, Annovazzi P, Ghezzi A, et al. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab I: fetal risks. Neurology. 2018;90(10):e823–831. doi:10.1212/WNL.0000000000005067
   PubMed Web of Science ®Google Scholar
• Hellwig K, Haghikia A, Gold R. Pregnancy and natalizumab: results of an observational study in 35 accidental pregnancies during natalizumab treatment. Mult Scler. 2011;17(8):958–963. doi:10.1177/1352458511401944
   PubMed Web of Science ®Google Scholar
• Ebrahimi N, Herbstritt S, Gold R, Amezcua L, Koren G, Hellwig K. Pregnancy and fetal outcomes following natalizumab exposure in pregnancy. A prospective, controlled observational study. Mult Scler. 2015;21(2):198–205. doi:10.1177/1352458514546790
   PubMed Web of Science ®Google Scholar
• Friend S, Richman S, Bloomgren G, Cristiano LM, Wenten M. Evaluation of pregnancy outcomes from the Tysabri® (natalizumab) pregnancy exposure registry: a global, observational, follow-up study. BMC Neurol. 2016;16(1):150. doi:10.1186/s12883-016-0674-4
   PubMed Web of Science ®Google Scholar
• Montalban X, Gold R, Thompson AJ, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler. 2018;24(2):96–120. doi:10.1177/1352458517751049
   PubMed Web of Science ®Google Scholar
• Houtchens MK, Kaplan TB. Reproductive issues in MS. Semin Neurol. 2017;37(6):632–642. doi:10.1055/s-0037-1608925
   PubMed Web of Science ®Google Scholar
• The European Medicines Agency - EMA. Mavenclad. Summary of product characteristics. (Online). Available from: https://ec.europa.eu/health/documents/community-register/2017/20170822138481/anx_138481_es.pdf. Accessed August 2, 2021.
   Google Scholar
• The European Medicines Agency - EMA. Lemtrada. Summary of product characteristics. (Online). Available from: https://www.ema.europa.eu/en/documents/product-information/lemtrada-epar-product-information_en.pdf. Accessed August 2, 2021.
   Google Scholar
• Klink DT, van Elburg RM, Schreurs MWJ, van Well GTJ. Rituximab administration in third trimester of pregnancy suppresses neonatal B-cell development. Clin Dev Immunol. 2008;2008:271363. doi:10.1155/2008/271363
   PubMedGoogle Scholar
• U.S. Food and Drug Administration – FDA. Ocrevus (ocrelizumab). Prescribing information. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/761053lbl.pdf. Accessed August 2, 2021.
   Google Scholar
• The European Medicines Agency - EMA. Ocrevus. Summary of product characteristics. Available from: https://www.ema.europa.eu/en/documents/product-information/ocrevus-epar-product-information_en.pdf. Accessed August 2, 2021.
   Google Scholar
• Stahnke AM, Holt KM. Ocrelizumab: a new B-cell therapy for relapsing remitting and primary progressive multiple sclerosis. Ann Pharmacother. 2018;52(5):473–483. doi:10.1177/1060028017747635
   PubMed Web of Science ®Google Scholar
• Langer-Gould AM. Pregnancy and family planning in multiple sclerosis. Continuum (Minneap Minn). 2019;25(3):773–792. doi:10.1212/CON.0000000000000745
   PubMedGoogle Scholar
• Alroughani R, Alowayesh MS, Ahmed SF, Behbehani R, Al-Hashel J. Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era. Neurology. 2018;90(10):e840–e846. doi:10.1212/WNL.0000000000005065
   PubMed Web of Science ®Google Scholar
• Oreja-Guevara C, Kobelt G, Berg J, Capsa D, Eriksson J. European multiple sclerosis platform. New insights into the burden and costs of multiple sclerosis in Europe: results for Spain. Mult Scler. 2017;23(Suppl 2):166–178. doi:10.1177/1352458517708672
   PubMed Web of Science ®Google Scholar
• Wang G, Marrie RA, Salter AR, et al. Health insurance affects the use of disease-modifying therapy in multiple sclerosis. Neurology. 2016;87(4):365–374. doi:10.1212/WNL.0000000000002887
   PubMed Web of Science ®Google Scholar
• Freedman MS. “Time is brain” also in multiple sclerosis. Mult Scler. 2009;15(10):1133–1134. doi:10.1177/1352458509345920
   PubMed Web of Science ®Google Scholar
• Goodin DS, Reder AT, Ebers GC, et al. Survival in MS: a randomized cohort study 21 years after the start of the pivotal IFNβ-1b trial. Neurology. 2012;78(17):1315–1322. doi:10.1212/WNL.0b013e3182535cf6
   PubMed Web of Science ®Google Scholar
• Trojano M, Pellegrini F, Paolicelli D, et al. Real-life impact of early interferonβ therapy in relapsing multiple sclerosis. Ann Neurol. 2009;66(4):513–520. doi:10.1002/ana.21757
   PubMed Web of Science ®Google Scholar
• Gajofatto A, Benedetti MD. Treatment strategies for multiple sclerosis: when to start, when to change, when to stop? World J Clin Cases. 2015;3(7):545–555. doi:10.12998/wjcc.v3.i7.545
   PubMed Web of Science ®Google Scholar
• Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet Glob Health. 2018;6(4):e380–e389. doi:10.1016/S2214-109X(18)30029-9
   PubMed Web of Science ®Google Scholar
• Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008– 2011. New Engl J Med. 2016;374(9):843–852. doi:10.1056/NEJMsa1506575
   PubMed Web of Science ®Google Scholar
• Hutchinson M. Safety first, efficacy second in disease modifying therapies. Mult Scler. 2011;17(4):380–381. doi:10.1177/1352458511402114
   PubMed Web of Science ®Google Scholar
• Broadley SA, Barnett MH, Boggild M, et al. Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective part 3 treatment practicalities and recommendations. J Clin Neurosci. 2014;21(11):1857–1865. doi:10.1016/j.jocn.2014.01.017
   PubMed Web of Science ®Google Scholar
• Miller DH, Fazekas F, Montalban X, Reingold SC, Trojano M. Pregnancy, sex and hormonal factors in multiple sclerosis. Mult Scler. 2014;20(5):527–536. doi:10.1177/1352458513519840
   PubMed Web of Science ®Google Scholar
• Thöne J, Thiel S, Gold R, Hellwig K. Treatment of multiple sclerosis during pregnancy–safety considerations. Expert Opin Drug Saf. 2017;16(5):523–534. doi:10.1080/14740338.2017.1311321
   PubMed Web of Science ®Google Scholar
• Houtchens MK, Edwards NC, Phillips AL. Relapses and disease-modifying drug treatment in pregnancy and live birth in US women with MS. Neurology. 2018;91(17):e1570–e1578. doi:10.1212/WNL.0000000000006382
   PubMed Web of Science ®Google Scholar
• Berenguer-Ruiz L, Gimenez-Martinez J, Palazón-Bru A, Sempere AP. Relapses and obstetric outcomes in women with multiple sclerosis planning pregnancy. J Neurol. 2019;266(10):2512–2517. doi:10.1007/s00415-019-09450-6
   PubMed Web of Science ®Google Scholar
• Khalid F, Healy BC, Dupuy SL, et al. Quantitative MRI analysis of cerebral lesions and atrophy in post-partum patients with multiple sclerosis. J Neurol Sci. 2018;392:94–99. doi:10.1016/j.jns.2018.06.025
   PubMed Web of Science ®Google Scholar
• The European Medicines Agency - EMA. Aubagio. Summary of product characteristics. Available from: https://www.ema.europa.eu/en/documents/product-information/aubagio-epar-product-information_en.pdf. Accessed August 2, 2021.
   Google Scholar
• Sepúlveda M, Montejo C, Llufriu S, et al. Rebound of multiple sclerosis activity after fingolimod withdrawal due to planning pregnancy: analysis of predisposing factors. Mult Scler Relat Disord. 2020;38:101483. doi:10.1016/j.msard.2019.101483
   PubMed Web of Science ®Google Scholar
• Barry B, Erwin AA, Stevens J, Tornatore C. Fingolimod rebound: a review of the clinical experience and management considerations. Neurol Ther. 2019;8(2):241–250. doi:10.1007/s40120-019-00160-9
   PubMed Web of Science ®Google Scholar
• Meinl I, Havla J, Hohlfeld R, Kümpfel T. Recurrence of disease activity during pregnancy after cessation of fingolimod in multiple sclerosis. Mult Scler. 2018;24(7):991–994. doi:10.1177/1352458517731913
   PubMed Web of Science ®Google Scholar
• Novi G, Ghezzi A, Pizzorno M, et al. Dramatic rebounds of MS during pregnancy following fingolimod withdrawal. Neurol Neuroimmunol NeuroInflamm. 2017;4(5):e377. doi:10.1212/NXI.0000000000000377
   PubMed Web of Science ®Google Scholar
• Sempere AP, Berenguer-Ruiz L, Feliu-Rey E. Rebound of disease activity during pregnancy after withdrawal of fingolimod. Eur J Neurol. 2013;20(8):109–110. doi:10.1111/ene.12195
   PubMed Web of Science ®Google Scholar
• Litwin T, Smoliński Ł, Członkowka A. Substantial disease exacerbation in a patient with relapsing-remitting multiple sclerosis after withdrawal from siponimod. Neurol Neurochir Pol. 2018;52(1):98–101. doi:10.1016/j.pjnns.2017.10.001
   PubMed Web of Science ®Google Scholar
• Lamb YN. Ozanimod: first Approval. Drugs. 2020;80(8):841–848. doi:10.1007/s40265-020-01319-7
   PubMed Web of Science ®Google Scholar
• The European Medicines Agency - EMA. Zeposia. Summary of product characteristics. Available from: https://www.ema.europa.eu/en/documents/product-information/zeposia-epar-product-information_en.pdf. Accessed August 2, 2021.
   Google Scholar
• The European Medicines Agency - EMA. Tysabri. Summary of product characteristics. Available from: https://www.ema.europa.eu/en/documents/product-information/tysabri-epar-product-information_en.pdf. Accessed August 2, 2021.
   Google Scholar
• Food and Drug Administration- FDA. Tysabri (Natalizumab) prescribing information. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/125104s0576lbl.pdf. Accessed August 2, 2021.
   Google Scholar
• de Giglio L, Gasperini C, Tortorella C, Trojano M, Pozzilli C. Natalizumab discontinuation and disease restart in pregnancy: a case series. Acta Neurol Scand. 2015;131(5):336–340. doi:10.1111/ane.12364
   PubMed Web of Science ®Google Scholar
• Razaz N, Piehl F, Frisell T, Langer-Gould AM, McKay KA, Fink K. Disease activity in pregnancy and postpartum in women with MS who suspended rituximab and natalizumab. Neurol Neuroimmunol Neuroinflamm. 2020;7(6):e903. doi:10.1212/NXI.0000000000000903
   PubMed Web of Science ®Google Scholar
• Vukusic S, Durand-Dubief F, Benoit A, Marignier R, Frangoulis B, Confavreux C. Natalizumab for the prevention of post-partum relapses in women with multiple sclerosis. Mult Scler. 2015;21(7):953–955. doi:10.1177/1352458514554056
   PubMed Web of Science ®Google Scholar
• Kleerekooper I, van Kempen ZLE, Leurs CE, et al. Disease activity following pregnancy-related discontinuation of natalizumab in MS. Neurol Neuroimmunol NeuroInflamm. 2017;5(1):e424. doi:10.1212/NXI.0000000000000424
   PubMed Web of Science ®Google Scholar
• Muller I, Moran C, Lecumberri B, et al. 2019 European Thyroid Association Guidelines on the management of thyroid dysfunction following immune reconstitution therapy. Eur Thyroid J. 2019;8(4):173–185. doi:10.1159/000500881
   PubMed Web of Science ®Google Scholar
• Oh J, Achiron A, Celius EG, et al. Pregnancy outcomes and postpartum relapse rates in women with RRMS treated with alemtuzumab in the Phase 2 and 3 clinical development program over 16 years. Mult Scler Relat Disord. 2020;43:102146. doi:10.1016/j.msard.2020.102146
   PubMed Web of Science ®Google Scholar
• Yalcin SE, Yalcin Y, Akkurt MO, Sezik M. Maternal and perinatal outcomes in pregnancies with multiple sclerosis: a case-control study. J Perinatal Med. 2017;45(4):455–460. doi:10.1515/jpm-2016-0060
   PubMed Web of Science ®Google Scholar
• Dobson R, Dassan P, Roberts M, Giovannoni G, Nelson-Piercy C, Brex PA. UK consensus on pregnancy in multiple sclerosis: “Association of British Neurologists” guidelines. Pract Neurol. 2019;19(2):106–114. doi:10.1136/practneurol-2018-002060
   PubMedGoogle Scholar
• Palacios C, Kostiuk LK, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2019;7(7):CD008873. doi:10.1002/14651858.CD008873.pub4
   PubMed Web of Science ®Google Scholar
• Traboulsee A, Simon JH, Stone L, et al. Revised recommendations of the consortium of MS centers task force for a standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of multiple sclerosis. AJNR Am J Neuroradiol. 2016;37(3):394–401. doi:10.3174/ajnr.A4539
   PubMed Web of Science ®Google Scholar
• Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316(9):952–961. doi:10.1001/jama.2016.12126
   PubMed Web of Science ®Google Scholar
• Lum M, Tsiouris AJ. MRI safety considerations during pregnancy. Clin Imaging. 2020;62:69–75. doi:10.1016/j.clinimag.2020.02.007
   PubMed Web of Science ®Google Scholar
• Mervak BM, Altun E, McGinty KA, Hyslop WB, Semelka RC, Burke LM. MRI in pregnancy: indications and practical considerations. J Magn Reson Imaging. 2019;49(3):621–631. doi:10.1002/jmri.26317
   PubMed Web of Science ®Google Scholar
• Haghikia A, Langer-Gould A, Rellensmann G, et al. Natalizumab use during the third trimester of pregnancy. JAMA Neurol. 2014;71(7):891–895. doi:10.1001/jamaneurol.2014.209
   PubMed Web of Science ®Google Scholar
• Triplett JD, Vijayan S, Rajanayagam S, Tuch P, Kermode AG. Pregnancy outcomes amongst multiple sclerosis females with third trimester natalizumab use. Mult Scler Relat Disord. 2020;40:101961. doi:10.1016/j.msard.2020.101961
   PubMed Web of Science ®Google Scholar
• Guilloton L, Pegat A, Defrance J, Quesnel L, Barral G, Drouet A. Neonatal pancytopenia in a child, born after maternal exposure to natalizumab throughout pregnancy. J Gynecol Obstet Hum Reprod. 2017;46(3):301–302. doi:10.1016/j.jogoh.2017.02.008
   PubMed Web of Science ®Google Scholar
• Dobson R, Hellwig K. Use of disease-modifying drugs during pregnancy and breastfeeding. Curr Opin Neurol. 2021;34(3):303–311. doi:10.1097/WCO.0000000000000922
   PubMed Web of Science ®Google Scholar
• Bomprezzi R, Pawate S. Extended interval dosing of natalizumab: a two-center, 7-year experience. Ther Adv Neurol Disord. 2014;7(5):227–231. doi:10.1177/1756285614540224
   PubMed Web of Science ®Google Scholar
• Riancho J, Setien S, Sánchez de la Torre JR, et al. Does extended interval dosing natalizumab preserve effectiveness in multiple sclerosis? A 7 year-retrospective observational study. Front Immunol. 2021;12:614715. doi:10.3389/fimmu.2021.614715
   PubMed Web of Science ®Google Scholar
• Zhovtis Ryerson L, Frohman TC, Foley J, et al. Extended interval dosing of natalizumab in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2016;87(8):885–889. doi:10.1136/jnnp-2015-312940
   PubMed Web of Science ®Google Scholar
• Yamout BI, Sahraian MA, Ayoubi NE. Efficacy and safety of natalizumab extended interval dosing. Mult Scler Relat Disord. 2018;24:113–116. doi:10.1016/j.msard.2018.06.015
   PubMed Web of Science ®Google Scholar
• Norberg H, Stålnacke J, Heijtz RD, et al. Antenatal corticosteroids for preterm birth: dose-dependent reduction in birthweight, length and head circumference. Acta Paediatr. 2011;100(3):364–369. doi:10.1111/j.1651-2227.2010.02074.x
   PubMed Web of Science ®Google Scholar
• Carmichael SL, Shaw GM, Ma C, et al. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol. 2007;197(6):585.e1–7. doi:10.1016/j.ajog.2007.05.046
   PubMed Web of Science ®Google Scholar
• Park-Wyllie L, Mazzotta P, Pastuszak A, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000;62(6):385–392. doi:10.1002/1096-9926(200012)62:6<385::AID-TERA5>3.0.CO;2-Z
   PubMedGoogle Scholar
• Skuladottir H, Wilcox AJ, Ma C, et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100(6):499–506. doi:10.1002/bdra.23248
   PubMed Web of Science ®Google Scholar
• Bandoli G, Palmsten K, Forbess Smith CJ, Chambers CD. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin North Am. 2017;43(3):489–502. doi:10.1016/j.rdc.2017.04.013
   PubMed Web of Science ®Google Scholar
• Räikkönen K, Gissler M, Kajantie E. Associations between maternal antenatal corticosteroid treatment and mental and behavioral disorders in children. JAMA. 2020;323(19):1924–1933. doi:10.1001/jama.2020.3937
   PubMed Web of Science ®Google Scholar
• Houtchens MK, Kolb CM. Multiple sclerosis and pregnancy: therapeutic considerations. J Neurol. 2013;260(5):1202–1214. doi:10.1007/s00415-012-6653-9
   PubMed Web of Science ®Google Scholar
• Fragoso YD, Adoni T, Brooks JBB, et al. Practical evidence-based recommendations for patients with multiple sclerosis who want to have children. Neurol Ther. 2018;7(2):207–232. doi:10.1007/s40120-018-0110-3
   PubMed Web of Science ®Google Scholar
• Rolfes L, Pfeuffer S, Ruck T, et al. Therapeutic apheresis in acute relapsing multiple sclerosis: current evidence and unmet needs—A systematic review. J Clin Med. 2019;8(10):1623. doi:10.3390/jcm8101623
   PubMed Web of Science ®Google Scholar
• Reyes S, Ramsay M, Ladhani S, et al. Protecting people with multiple sclerosis through vaccination. Pract Neurol. 2020;20(6):435–445. doi:10.1136/practneurol-2020-002527
   PubMedGoogle Scholar
• Otero-Romero S, Rodríguez-García J, Vilella A, et al. Recommendations for vaccination in patients with multiple sclerosis who are eligible for immunosuppressive therapies: Spanish consensus statement. Neurologia (Engl Ed). 2021;36(1):50–60. doi:10.1016/j.nrl.2020.02.006
   PubMed Web of Science ®Google Scholar
• Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. N Engl J Med. 2021;384(24):2273–2282. doi:10.1056/NEJMoa2104983
   PubMed Web of Science ®Google Scholar
• Acog.org (homepage on the Internet). American College of Obstetricians and Gynecologists. COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care. [updated July 30, 2021]. Available from: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care. Accessed December 22, 2021.
   Google Scholar
• Canada.ca (homepage on the Internet). National Advisory Committee on Immunization. Public Health Agency of Canada. Recommendations on the use of COVID-19 Vaccines; July 22, 2021. Available from: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines.html. Accessed December 22, 2021.
   Google Scholar
• Australian Technical Advisory Group on Immunisation (ATAGI). Clinical guidance on use of COVID-19 vaccine in Australia in 2021. Version 6.0; July 30, 2021. Available from: https://www.health.gov.au/sites/default/files/documents/2021/08/covid-19-vaccination-atagi-clinical-guidance-on-covid-19-vaccine-in-australia-in-2021_0.pdf. Accessed August 2, 2021.
   Google Scholar
• Limia Sanchez A, Navarro JA, Armona Aquerreta JM Vaccination working group in the adult population and risk groups of the Vaccination Program and Registry Report. Vaccination in risk groups of all ages and in certain situations. Public Health Commission of the Interterritorial Council of the National Health System. Ministry of Health, Consumption and Social Welfare, July 2018.: 137–145. Available from: http://www.ffis.es/ups/prl/vacunacion_grupos_riesgo.pdf. Accessed December 22, 2021.
   Google Scholar
• Portaccio E, Ghezzi A, Hakiki B, et al. Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs. J Neurol Neurosurg Psychiatry. 2014;85(8):845–850. doi:10.1136/jnnp-2013-306054
   PubMed Web of Science ®Google Scholar
• Achiron A, Kishner I, Dolev M, et al. Effect of intravenous immunoglobulin treatment on pregnancy and postpartum- related relapses in multiple sclerosis. J Neurol. 2004;251:1133–1137. doi:10.1007/s00415-004-0495-z
   PubMed Web of Science ®Google Scholar
• Brandt-Wouters E, Gerlach OH, Hupperts RM. The effect of postpartum intravenous immunoglobulins on the relapse rate among patients with multiple sclerosis. Int J Gynecol Obstet. 2016;134(2):194–196. doi:10.1016/j.ijgo.2016.01.008
   PubMed Web of Science ®Google Scholar
• Haas J, Hommes OR. A dose comparison study of IVIG in postpartum relapsing-remitting multiple sclerosis. Mult Scler. 2007;13(7):900–908. doi:10.1177/1352458506075654
   PubMed Web of Science ®Google Scholar
• Hellwig K, Beste C, Schimrigk S, Chan A. Immunomodulation and postpartum relapses in patients with multiple sclerosis. Ther Adv Neurol Disord. 2009;2(1):7–11. doi:10.1177/1756285608100416
   PubMedGoogle Scholar
• Orvieto R, Achiron R, Rotstein Z, Noy S, Bar-Hava I, Achiron A. Pregnancy and multiple sclerosis: a 2-year experience. Eur J Obstet Gynecol Reprod Biol. 1999;82(2):191–194. doi:10.1016/S0301-2115(98)00231-0
   PubMed Web of Science ®Google Scholar
• Fragoso YD, Adoni T, Alves-Leon SV, et al. Postpartum treatment with immunoglobulin does not prevent relapses of multiple sclerosis in the mother. Health Care Women Int. 2015;36(10):1072–1080. doi:10.1080/07399332.2014.948627
   PubMed Web of Science ®Google Scholar
• Horvat Ledinek A, Brecl Jakob G, Jerše J, et al. Intravenous immunoglobulins for the prevention of postpartum relapses in multiple sclerosis. Mult Scler Related Disord. 2020;38:101519. doi:10.1016/j.msard.2019.101519
   PubMed Web of Science ®Google Scholar
• Rosa GR, O’Brien AT, Nogueira ED, Carvalho VM, Paz SC, Fragoso YD. There is no benefit in the use of postnatal intravenous immunoglobulin for the prevention of relapses of multiple sclerosis: findings from a systematic review and meta-analysis. Arq Neuropsiquiatr. 2018;76(6):361–366. doi:10.1590/0004-282x20180041
   PubMed Web of Science ®Google Scholar
• de Seze J, Chapelotte M, Delalande S, Ferriby D, Stojkovic T, Vermersch P. Intravenous corticosteroids in the postpartum period for reduction of acute exacerbations in multiple sclerosis. Mult Scler. 2004;10(5):596–597. doi:10.1191/1352458504ms1079sr
   PubMed Web of Science ®Google Scholar
• Avila-Ornelas J, Avila M, Stosic M, et al. The role of postpartum intravenous corticosteroids in the prevention of relapses in multiple sclerosis. Int J MS Care. 2011;13:91–93. doi:10.7224/1537-2073-13.2.91
   PubMedGoogle Scholar
• Durand-Dubief F, El-Etr M, Ionescu I, et al. The POPARTMUS French-Italian multicentric trial of postpartum progestin and estradiol in multiple sclerosis: MRI findings. Abstract (P063) at the ECTRIMS 2014 congress; September 10–13, 2014; Boston, USA. Available from: https://onlinelibrary.ectrims-congress.eu. Accessed December 22, 2021.
   Google Scholar
• Beaber BE, Chi MD, Brara MS, Zhang JL, Langer-Gould AM. Immunomodulatory agents and risk of postpartum multiple sclerosis relapses. Perm J. 2014;18(1):9–13. doi:10.7812/TPP/13-090
   PubMedGoogle Scholar
• Portaccio E, Amato MP. Breastfeeding and post-partum relapses in multiple sclerosis patients. Mult Scler. 2019;25(9):1211–1216. doi:10.1177/1352458519830588
   PubMed Web of Science ®Google Scholar
• Krysko KM, Rutatangwa A, Graves J, Lazar A, Waubant E. Association between breastfeeding and postpartum multiple sclerosis relapses: a systematic review and meta-analysis. JAMA Neurol. 2020;77(3):327–338.
   PubMed Web of Science ®Google Scholar
• Langer-Gould A, Huang SM, Gupta R, et al. Exclusive breastfeeding and the risk of postpartum relapses in women with multiple sclerosis. Arch Neurol. 2009;66(8):958–963. doi:10.1001/archneurol.2009.132
   PubMedGoogle Scholar
• Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–490. doi:10.1016/S0140-6736(15)01024-7
   PubMed Web of Science ®Google Scholar
• Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin North Am. 2013;60(1):31–48. doi:10.1016/j.pcl.2012.09.010
   PubMed Web of Science ®Google Scholar
• Sattari M, Serwint JR, Levine DM. Maternal implications of breastfeeding: a review for the internist. Am J Med. 2019;132(8):912–920. doi:10.1016/j.amjmed.2019.02.021
   PubMed Web of Science ®Google Scholar
• Almas S, Vance J, Baker T, Hale T. Management of multiple sclerosis in the breastfeeding mother. Multiple Scler Int. 2016;2016:6527458.
   PubMed Web of Science ®Google Scholar
• Hale TW, Siddiqui AA, Baker TE. Transfer of interferon β-1a into human breastmilk. Breastfeed Med. 2012;7(2):123–125. doi:10.1089/bfm.2011.0044
   PubMed Web of Science ®Google Scholar
• The European Medicines Agency - EMA. Rebif. Summary of product characteristics. Available from: https://www.ema.europa.eu/en/documents/product-information/rebif-epar-product-information_en.pdf. Accessed August 2, 2021.
   Google Scholar
• Datta P, Ciplea AI, Rewers-Felkins K, et al. Cladribine transfer into human milk: a case report. Mult Scler. 2021;27(5):799–801. doi:10.1177/1352458520912173
   PubMed Web of Science ®Google Scholar
• Drugs and Lactation Database (LactMed) [Internet]. Ocrelizumab. Bethesda (MD): National Library of Medicine (US); 2006 [updated July 20, 2020]. https://www.ncbi.nlm.nih.gov/books/. Accessed December 22, 2021.
   Google Scholar
• Proschmann U, Thomas K, Thiel S, Hellwig K, Ziemssen T. Natalizumab during pregnancy and lactation. Mult Scler. 2018;24(12):1627–1634. doi:10.1177/1352458517728813
   PubMed Web of Science ®Google Scholar
• LaHue SC, Anderson A, Krysko KM, et al. Transfer of monoclonal antibodies into breastmilk in neurologic and non-neurologic diseases. Neurol Neuroimmunol Neuroinflamm. 2020;7(4):e769. doi:10.1212/NXI.0000000000000769
   PubMed Web of Science ®Google Scholar
• Baker TE, Cooper SD, Kessler L, Hale TW. Transfer of natalizumab into breast milk in a mother with multiple sclerosis. J Hum Lact. 2015;31(2):233–236. doi:10.1177/0890334414566237
   PubMed Web of Science ®Google Scholar
• Ciplea AI, Langer-Gould A, de Vries A, et al. Monoclonal antibody treatment during pregnancy and/or lactation in women with MS or neuromyelitis optica spectrum disorder. Neurol Neuroimmunol Neuroinflamm. 2020;7(4):e723.
   PubMed Web of Science ®Google Scholar
• Tailor K, Bove R, Oreja-Guevara C, et al. Pregnancy outcomes in patients treated with ocrelizumab. ePoster (P1132) at the MSVirtual/Virtual 8th Joint ACTRIMS-ECTRIMS Meeting; September 11–13, 2020.
   Google Scholar
• Cooper SD, Felkins K, Baker TE, Hale TW. Transfer of methylprednisolone into breast milk in a mother with multiple sclerosis. J Hum Lact. 2015;31(2):237–239. doi:10.1177/0890334415570970
   PubMed Web of Science ®Google Scholar
• Kaplan TB. Management of demyelinating disorders in pregnancy. Neurol Clin. 2019;37(1):17–30. doi:10.1016/j.ncl.2018.09.007
   PubMed Web of Science ®Google Scholar
• Kraemer M, Weber R, Herold M, Berlit P. Reversible cerebral vasoconstriction syndrome associated with fingolimod treatment in relapsing-remitting multiple sclerosis three months after childbirth. Mult Scler. 2015;21(11):1473–1475. doi:10.1177/1352458515600249
   PubMed Web of Science ®Google Scholar
• Voskuhl R, Momtazee C. Pregnancy: effect on multiple sclerosis, treatment considerations, and breastfeeding. Neurotherapeutics. 2017;14(4):974–984.
   PubMed Web of Science ®Google Scholar
• ACOG Committee on Obstetric Practice. Committee Opinion No. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210–e216. doi:10.1097/AOG.0000000000002355
   PubMed Web of Science ®Google Scholar
• Das G, Damotte V, Gelfand JM, et al. Rituximab before and during pregnancy: a systematic review, and a case series in MS and NMOSD. Neurol Neuroimmunol Neuroinflamm. 2018;5(3):e453. doi:10.1212/NXI.0000000000000453
   PubMed Web of Science ®Google Scholar
• Chakravarty EF, Murray ER, Kelman A, Farmer P. Pregnancy outcomes after maternal exposure to rituximab. Blood. 2011;117(5):1499–1506. doi:10.1182/blood-2010-07-295444
   PubMed Web of Science ®Google Scholar
• The European Medicines Agency - EMA. Kesimpta. Summary of product characteristics. Available from: https://www.ema.europa.eu/en/documents/product-information/kesimpta-epar-product-information_en.pdf. Accessed November 20, 2021.
   Google Scholar
• The European Medicines Agency - EMA. Ponvory. Summary of product characteristics. Available from: https://www.ema.europa.eu/en/documents/product-information/ponvory-epar-product-information_en.pdf. Accessed November 20, 2021.
   Google Scholar