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Multiple Sclerosis Editorial Multiple Sclerosis and Pregnancy Riley Bove, MD, MMSC Assistant Professor of Neurology, Harvard Medical School; Associate Neurologist, Brigham and Women’s Hospital, Boston, Massachusetts, US Abstract For many women with multiple sclerosis (MS), bearing and breastfeeding a child can be undertaken safely with the management of an informed medical provider. In the past year, the need for a North American MS pregnancy registry has come into sharper focus; reports from a multicenter randomized estriol trial have been presented, and the scope of investigations has widened beyond mothers to include fathers with MS, as well as children of parents with MS. More data are anticipated regarding the effects of breastfeeding and fertility treatments on MS course, as well as ideal levels of vitamin D during pregnancy. Keywords Pregnancy, multiple sclerosis, registry, fatherhood, fertility, vitamin D Disclosure: Riley Bove, MD, MMSC, has received research funding from the National Multiple Sclerosis Society and the American Brain Foundation. No funding was received for the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: July 1, 2015 Published Online: September 28, 2015 Citation: US Neurology, 2015;11(2):87–8 Correspondence: Riley Bove, MD, MMSC, Assistant Professor of Neurology, Harvard Medical School; Associate Neurologist, Brigham and Women’s Hospital, Boston, Massachusetts, US. E: rbove@bwh.harvard.edu The importance of pregnancy management in multiple sclerosis (MS) is underscored by the fact that MS affects three times more women than men, with first symptoms typically during the peak reproductive years. Childbearing—An Achievable Goal for Many Women with Multiple Sclerosis While providers were cautious in prior decades, it is increasingly clear that most women with MS who wish to can safely become pregnant, carry a pregnancy, and breastfeed their newborn. There appear to be minimal effects of maternal MS on neonatal outcomes. Additionally, childbearing does not appear to adversely affect long-term MS outcomes and may even be protective, although data are patchy. 1 However, many questions remain about optimal MS management during this timeframe. To address these questions, there have been many recent important developments. Helping Women with Multiple Sclerosis Achieve their Family Planning Goals It is noteworthy that several reviews of pregnancy management in MS have been published, by teams of MS providers 2 as well as by multidisciplinary groups, such as MS Centers for Excellence in Reproduction and Child Health. 1,2 These publications reflect a need to synthesize evidence from a broadening field into consensus guidelines that can be used by neurologic and obstetric providers. Tou ch MEd ica l MEdia A Need for Multiple Sclerosis-specific Pregnancy Registries Most MS providers recommend discontinuation of disease-modifying therapies (DMTs) prior to conception and during pregnancy. 3 Typically, DMTs should be discontinued at last 5 maximal half lives prior to conception (with the exception being teriflunomide, where according to the manufacturer, conception should be tied to serum drug levels). Despite these guidelines, there are many unknowns. For instance, many studies, including one by Dr Kerstin Hellwig and colleagues in Germany, have reported no increased risk for fetal malformations in pregnancies exposed to glatiramer acetate. 4 On the other hand, instances of possible abnormal fetal development associated with fingolimod have been reported. 5 To achieve broader comparative data across a range of DMTs, a North American MS pregnancy registry is essential. 6 In response, the Autoimmune Diseases in Pregnancy Project created by the Organization of Teratology Information Specialists in 2012 has begun monitoring pregnancies in women with MS to evaluate the effect of the disease and its related treatments on the birth outcome. Managing Women through Pregnancy— More Data Required In addition to the critical information to be gleaned from MS drug registries, further studies are needed to guide women with MS and their providers in three important areas. 87