To review the peripartum management of women with MS and assess postpartum MS outcomes from a tertiary referral MS centre.

The management of women with MS planning pregnancy has evolved in the past decade as information from pregnancy registries and real-world evidence emerges.

Thirty-five pregnancies occurred in 31 women with MS between 2018 and July 2024; mean age 34 (27-41), median disease duration 6-years (1-16). At conception, 6 patients (17%) were not receiving DMT, 10 (28%) on platform injectables, 4 (11%) on dimethyl fumarate (DMF), 7 (20%) on Natalizumab, 4 (11%) on Ocrelizumab, 3 (0.8%) had recent courses of cladribine. One received alemtuzumab 7-years pre-conception.

Four pregnancies were unplanned; 2 between courses of cladribine, one had received ocrelizumab when unknowingly four-weeks pregnant and one reported a pregnancy during the work-up for DMF. Three patients discontinued fingolimod prior to planned conception; with one switching to natalizumab without any post-fingolimod relapse, another to copaxone with a steroid-bridge and one proceeding without DMT. The latter two had evidence of disease activity post-fingolimod. Those on DMF discontinued at positive pregnancy test. Natalizumab was discontinued in the third trimester (between weeks 28 and 31-weeks), though one discontinued at 24-weeks. Ocrelizumab was last administered between 3–12 months of conception. Eleven (34%) had an active MRI pre-conception. Three (0.8%) clinically relapsed during pregnancy while two (0.6%) relapsed post-pregnancy. 15 of 32 MRIs (47%) showed evidence of disease activity post-pregnancy. One patient had confirmed disability accrual post-pregnancy. 

This data supports the current use of DMTs to the point of conception and during pregnancy where appropriate, and may be protective against disease activity during pregnancy and post-partum.