Pregnancy and multiple sclerosis (MS): pre-conception management

Pre-conception counselling

• This should be offered to all women with MS of childbearing age
• Counselling should start early
• Discuss the high risk of post-partum relapse and their mitigation by
• Discuss the risk of reduced hormonal contraceptive levels with Dimethyl fumarate

Pre-conception guidelines for low activity disease

Pre-conception guidelines for highly active disease

Pre-conception guidelines for stopping DMTs

References

1. 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; 19:106-114.
2. Iyer P, Dobson R. Multiple sclerosis in pregnancy: a commentary on disease modification and symptomatic drug therapies. Neurol Ther 2023; 12:1-10. 
3. Collorone S, Kodali S, Toosy AT. The protective role of breastfeeding in multiple sclerosis: Latest evidence and practical considerations. Front Neurol 2023; 13:1090133. 
4. Montalban X, Gold R, Thompson AJ, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Eur J Neurol 2018; 25:215-237.
5. Alroughani R, Altintas A, Al Jumah M, et al. Pregnancy and the use of disease-modifying therapies in patients with multiple sclerosis: benefits versus risks. Mult Scler Int 2016; 2016:1034912.
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Related checklists

• Pregnancy and multiple sclerosis (MS): drug safety
• Pregnancy and multiple sclerosis (MS): relapse management
• Pregnancy and multiple sclerosis (MS): breastfeeding management