Multiple Sklerose in Schwangerschaft und Stillzeit

Multiple Sklerose (MS) betrifft primär Frauen im gebärfähigen Alter. Daher stellt sich die Frage, welche MS-Therapien mit einer Familienplanung vereinbar sind. Es gilt, die Therapieoption mit dem größten Nutzen für die Mutter und dem geringsten Risiko für das Kind zu finden. Dieser Artikel fasst die aktuelle Datenlage zur Anwendung von verlaufsmodifizierender Therapie (Disease modifying Therapy, DMT) in der Schwangerschaft und Stillzeit zusammen.

Schlüsselwörter

Multiple Sklerose - Schwangerschaft - Stillzeit - Schwangerschaftsplanung - MS

• Literatur

• 1 Krysko KM, Dobson R, Alroughani R. et al. Family planning considerations in people with multiple sclerosis. Lancet Neurol 2023; 22: 350-366
• 2 Rasmussen PV, Magyari M, Moberg JY. et al. Patient awareness about family planning represents a major knowledge gap in multiple sclerosis. Mult Scler Relat Disord 2018; 24: 129-134
• 3 Krysko KM, Graves JS, Dobson R. et al. Sex effects across the lifespan in women with multiple sclerosis. Ther Adv Neurol Disord 2020; 13: 1756286420936166
• 4 Lamaita R, Melo C, Laranjeira C. et al. Multiple sclerosis in pregnancy and its role in female fertility: a systematic review. JBRA Assist Reprod 2021; 25: 493-499
• 5 Andersen ML, Jølving LR, Stenager E. et al. Maternal multiple sclerosis and health outcomes among the children: a systematic review. Clin Epidemiol 2023; 15: 375-389
• 6 Mainguy M, Tillaut H, Degremont A. et al. Assessing the risk of relapse requiring corticosteroids after in vitro fertilization in women with multiple sclerosis. Neurology 2022;
• 7 Andersen JB, Moberg JY, Spelman T. et al. Pregnancy outcomes in men and women treated with teriflunomide. A population-based nationwide Danish register study. Front Immunol 2018; 9: 2706
• 8 Reyes S, Ramsay M, Ladhani S. et al. Protecting people with multiple sclerosis through vaccination. Pract Neurol 2020; 20: 435-445
• 9 BfArM. Rote-Hand-Brief zu Fingolimod (Gilenya): Neue Kontraindikation bei Anwendung während der Schwangerschaft und bei Frauen im gebärfähigen Alter. (2019). Accessed July 11, 2023 at: https://www.bfarm.de/SharedDocs/Risikoinformationen/Pharmakovigilanz/DE/RHB/2019/rhb-gilenya.html
• 10 Dubinsky MC, Mahadevan U, Charles L. et al. DOP53 Pregnancy outcomes in the ozanimod clinical development program in relapsing multiple sclerosis, Ulcerative Colitis, and Crohn’s Disease. J Crohns Colitis 2021; 15: S088-S089
• 11 Dobson R, Rog D, Ovadia C. et al. Anti-CD-20 therapies in pregnancy and breast feeding: a review and ABN guidelines. Pract Neurol 2023; 23: 6-14
• 12 Landi D, Bovis F, Grimaldi A. et al. Exposure to natalizumab throughout pregnancy: effectiveness and safety in an Italian cohort of women with multiple sclerosis. J Neurol Neurosurg Psychiatry 2022; 93: 1306-1316
• 13 Litvin N, Thiel S, Haben S. et al. Disease activity and pregnancy outcomes after different natalizumab exposure patterns during pregnancy in women with MS - Results from the German Multiple Sclerosis and Pregnancy Registry. DGN-Kongress Berlin 2021 (Poster).
• 14 Hellwig K, Tokic M, Thiel S. et al. Multiple sclerosis disease activity and disability following discontinuation of natalizumab for pregnancy. JAMA Netw Open 2022; 5: e2144750
• 15 Bianco A, Lucchini M, Totaro R. et al. Disease reactivation after fingolimod discontinuation in pregnant multiple sclerosis patients. Neurotherapeutics 2021; 18: 2598-2607
• 16 Dost-Kovalsky K, Thiel S, Ciplea AI. et al. Cladribine and pregnancy in women with multiple sclerosis: the first cohort study. Mult Scler 2023; 29: 461-465
• 17 Hoffmann F, Kraft A, Heigl F. et al. Tryptophan immunoadsorption during pregnancy and breastfeeding in patients with acute relapse of multiple sclerosis and neuromyelitis optica. Ther Adv Neurol Disord 2018; 11: 1756286418774973
• 18 Dost-Kovalsky K, Thiel S, Ciplea AI. et al. Immunoadsorption, therapeutic plasma exchange and pregnancy in women with multiple sclerosis - a case series. ANZAN-Kongress 2022 (Poster).
• 19 Wang J, Johnson T, Sahin L. et al. Evaluation of the safety of drugs and biological products used during lactation: workshop summary. Clin Pharmacol Ther 2017; 101: 736-744
• 20 Langer-Gould A, Smith JB, Albers KB. et al. Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort. Neurology 2020; 94: e1939-e1949