Stoll has served on scientific advisory boards for Bristol Myers Squibb, F

Stoll has served on scientific advisory boards for Bristol Myers Squibb, F. and breastfeeding. Summary Management of family planning and pregnancy in patients with MS requires the most current information. Health care providers should discuss family planning early and frequently with patients with MS, and partners where practicable. Because management of pregnant people with MS will often require a risk/benefit analysis of their needs, shared decision-making in family planning discussions is usually emphasized. Additional data are needed for specific and underrepresented populations with MS (e.g., single parents or those from your LGBTQ+ community) and those at risk of racial and socioeconomic disparities in care. Pregnancy registries and the design and conduct of clinical trials focused on pregnant and lactating patients should provide additional data to guide the ongoing management of patients with MS. Introduction Multiple sclerosis (MS) is typically diagnosed between the ages of 20 and 50 years.e1 Because most patients with MS are women (approximately 70%), diagnosis often coincides with patients’ reproductive years.e1 Historically, women with MS have been discouraged from pregnancy;e2,e3 however, evidence suggests that pregnancy does not adversely affect the long-term course of MS and may even have a beneficial effect in MS, with overall better MS outcomes in patients who have been pregnant compared with those who have not.1 In the short term, pregnant women with MS often experience a substantial reduction in relapse rates, especially in the third trimester.e4 However, risk of postpartum disease rebound requires concern and careful management. An increased risk of contamination and preterm birth was noted in a study SEA0400 of 3,875 pregnant women with MS in US databases, with an unclear association between this risk and the use of disease-modifying therapies (DMTs); however, other pregnancy or fetal complications were not elevated in pregnant women with MS. e5 Although treatment paradigms in MS have developed rapidly over the past decade, pregnant and lactating women have been excluded from phase 3 trials, SEA0400 and labeling for DMTs precludes their use during pregnancy (Physique 1; additional details are summarized in eTable 1, links.lww.com/CPJ/A500). Pregnancy security evidence is usually often based on real-world data originating from pharmaceutical organization postmarketing registries or claims databases.e5-e7 For some treatments, real-world data are often borrowed from other indications. For example, the pyrimidine synthesis inhibitor leflunomide, whose SEA0400 active metabolite is the MS DMT teriflunomide, is usually indicated for the treatment of rheumatoid arthritis. The security of teriflunomide use during pregnancy, which is usually contraindicated, has been informed by pregnancy data from leflunomide.e8 Despite this, using DMTs to better control disease in young women, along with active treatment of patients prepregnancy, intrapregnancy, and postpregnancy, has resulted in a significant improvement in outcomes, with a decrease in the risk of disability, an improvement in quality of life, and more autonomy for pregnancy planning for women living with MS.e4,e9,e10 Open in a separate window Determine 1 US FDA/EMA Guidelines for DMT Use During Pregnancy*Observe eTable 1 (links.lww.com/CPJ/A500) for further details and Health Canada guidelines. *Color coding represents the authors’ interpretation of agency guidelines and literature to date. Green cells show CDK4I that this DMT can be used during pregnancy; SEA0400 yellow cells indicate that this DMT may be used based on the balance of benefit and risk; reddish cells show that this DMT should not be used during SEA0400 pregnancy. DMT = disease-modifying therapy; EMA = European Medicines Agency; US FDA = US Food and Drug Administration; S1P = sphingosine-1-phosphate. In the past, an escalation treatment strategy has been used in MS.e11 With this approach, moderate-efficacy therapies with low side effect profiles are.