Krysko Kristen M, Bove Riley, Dobson Ruth, Jokubaitis Vilija, Hellwig Kerstin
UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA 94158 USA.
Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 9 Donnelly Wing South, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada.
Curr Treat Options Neurol. 2021;23(4):11. doi: 10.1007/s11940-021-00666-4. Epub 2021 Mar 30.
We review data available for treatment of multiple sclerosis (MS) before, during, and after pregnancy. We present recent data on disease-modifying therapies (DMT) before/during pregnancy and while breastfeeding, with treatment recommendations.
Observational data support the safety of injectable DMTs (glatiramer acetate, interferon-beta) for use in pregnancy, while some oral DMTs might be associated with fetal risk. Monoclonal antibodies (mAbs) before pregnancy such as rituximab or natalizumab likely do not pose significant fetal risks, but can cross the placenta with neonatal hematological abnormalities if given in the second trimester or later. Breastfeeding is associated with decreased risk of postpartum relapses. Finally, injectables and mAbs likely have low transfer into breastmilk.
Many women with MS do not require DMTs during pregnancy, although injectables could be continued. For women with highly active MS, cell-depleting therapies could be given before conception, or natalizumab could be continued through pregnancy, with monitoring of the fetus. Women should be encouraged to breastfeed, and those with higher relapse risk could consider injectables or mAbs while breastfeeding. Further data on safety of DMTs around pregnancy are needed. Maximizing function through non-pharmacologic approaches is complementary to DMTs. Special considerations for pregnancy and DMTs during the COVID-19 pandemic are needed.
我们回顾了妊娠前、妊娠期间及妊娠后用于治疗多发性硬化症（MS）的现有数据。我们展示了妊娠前/期间及哺乳期疾病修正疗法（DMT）的最新数据，并给出治疗建议。
观察性数据支持注射用DMT（醋酸格拉替雷、干扰素-β）在妊娠期间使用的安全性，而一些口服DMT可能与胎儿风险相关。妊娠前使用的单克隆抗体（mAb），如利妥昔单抗或那他珠单抗可能不会对胎儿造成重大风险，但如果在孕中期或更晚使用，可穿过胎盘并导致新生儿血液学异常。母乳喂养与产后复发风险降低相关。最后，注射剂和mAb进入母乳的量可能较低。
许多患有MS的女性在妊娠期间不需要DMT，不过注射剂可以继续使用。对于MS高度活跃的女性，可以在受孕前给予细胞清除疗法，或者那他珠单抗可以在整个妊娠期间继续使用，并对胎儿进行监测。应鼓励女性进行母乳喂养，复发风险较高的女性在母乳喂养期间可考虑使用注射剂或mAb。需要更多关于妊娠前后DMT安全性的数据。通过非药物方法最大化功能是对DMT的补充。在2019冠状病毒病大流行期间，妊娠和DMT需要特殊考虑。
