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Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach

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A Correction to this article was published on 26 December 2017

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Abstract

Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system (CNS), most probably autoimmune in origin, usually occurring in young adults with a female/male prevalence of approximately 3:1. Women with MS in the reproductive age may face challenging issues in reconciling the desire for parenthood with their condition, owing to the possible influence both on the ongoing or planned treatment with the possible consequences on the disease course and on the potential negative effects of treatments on foetal and pregnancy outcomes. At MS diagnosis, timely counselling should promote informed parenthood, while disease evolution should be assessed before making therapeutic decisions. Current guidelines advise the discontinuation of any treatment during pregnancy, with possible exceptions for some treatments in patients with very active disease. Relapses decline during pregnancy but are more frequent during puerperium, when MS therapy should be promptly resumed in most of the cases. First-line immunomodulatory agents, such as interferon-β (IFN-β) and glatiramer acetate (GA), significantly reduce the post-partum risk of relapse. Due to substantial evidence of safety with the use of GA during pregnancy, a recent change in European marketing authorization removed the pregnancy contraindication for GA. This paper reports a consensus of Italian experts involved in MS management, including neurologists, gynaecologists and psychologists. This consensus, based on a review of the available scientific evidence, promoted an interdisciplinary approach to the management of pregnancy in MS women.

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Change history

  • 26 December 2017

    The original version contained a mistake. The authors have specified only in a few paragraphs that all the contents of the paper are meant for Copaxone but not for unbranded glatiramer acetate, Authors ask to add the specification of Copaxone or branded glatiramer acetate everytime.

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Acknowledgements

We thank Luisa Granziero and Ray Hill, independent medical writers, who provided editorial assistance, respectively, in manuscript drafting and in English-language editing and journal styling prior to submission. This assistance was funded by Teva.

Author information

Authors and Affiliations

  1. Department NEUROFARBA, Section Neurological Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy

    Maria Pia Amato & Benedetta Goretti

  2. Neurology 2-CRESM (Multiple Sclerosis Regional Reference Center), AOU San Luigi Gonzaga, Orbassano, Torino, Italy

    Antonio Bertolotto

  3. Department of Gynecology, Obstetrics and Urology, Umberto I Hospital, Sapienza University of Rome, Rome, Italy

    Roberto Brunelli

  4. Neurology 1 and Multiple Sclerosis Center, City of Health and Science Turin University Hospital, Turin, Italy

    Paola Cavalla

  5. Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy

    Maria Giovanna Marrosu

  6. G.F. Ingrassia Department of Medical and Surgical Sciences and Advanced Technologies, Multiple Sclerosis Center, University of Catania, Catania, Italy

    Francesco Patti

  7. Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy

    Carlo Pozzilli

  8. Department of Experimental and Clinical Medicine, 1 Neurological Clinic, Marche Polytechnic University, Ancona, Italy

    Leandro Provinciali

  9. Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St Orsola Malpighi Hospital, University of Bologna, Bologna, Italy

    Nicola Rizzo

  10. Gynecology and Obstetrics Department, Hospital Papa Giovanni XXIII, Bergamo, Italy

    Nicola Strobelt

  11. Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Università della Campania “L. Vanvitelli”, Naples, Italy

    Gioacchino Tedeschi

  12. Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy

    Maria Trojano

  13. Department of Neurology, INSPE, San Raffaele Scientific Institute, Milan, Italy

    Giancarlo Comi

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Corresponding author

Correspondence to Maria Pia Amato.

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Conflicts of interest

Maria Pia Amato has received research grants and honoraria as a speaker and member of advisory boards from Bayer, Biogen, Merck, Novartis, Roche, Sanofi Genzyme and Teva. Paola Cavalla has received speaker honoraria and honoraria for serving on advisory board activities from Almirall, Biogen, Merck Serono, Novartis, Sanofi Genzyme and Teva. Giancarlo Comi has received compensation for consulting services and/or speaking activities from Teva, Novartis, Sanofi, Genzyme, Merck, Biogen, Roche, Almirall, Receptos, Celgene, Forward Pharma and Excemed. Maria Giovanna Marrosu has received speaker honoraria and honoraria for serving on advisory board activities from Bayer Schering, Biogen Idec, Merck Serono, Novartis, Genzyme, Sanofi Aventis and Teva and research grants from Merck Serono and Novartis. Francesco Patti has received fees for consulting and/or advisory board activities from Almirall, Bayer, Biogen, Celgene, Merck, Novartis, Roche, Sanofi Genzyme and Teva. All other authors declare no conflict of interest.

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A correction to this article is available online at https://doi.org/10.1007/s10072-017-3226-9.

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Amato, M.P., Bertolotto, A., Brunelli, R. et al. Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach. Neurol Sci 38, 1849–1858 (2017). https://doi.org/10.1007/s10072-017-3081-8

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  • DOI: https://doi.org/10.1007/s10072-017-3081-8

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