Women are three times more likely to be diagnosed with multiple sclerosis (MS) than men, and the disease is more common in women of childbearing age than all other age groups. That makes conversations about family planning essential.
B-cell therapy is an effective treatment option for relapsing-remitting multiple sclerosis (RRMS) that has been shown to reduce relapses and slow treatment progression.
Despite the effectiveness ocrelizumab (Ocrevus), ofatumumab (Kesimpta), and ublituximab-xiiy (Briumvi), the FDA-approved medications used to treat RRMS come with significant warnings for those who are pregnant or plan to become pregnant.
RRMS and Pregnancy
In the past, women with multiple sclerosis were advised against having children. Newer research found that relapses decreased during pregnancy, especially in the third trimester, but increased after pregnancy with up to 31% of women experiencing a relapse within 3 months of giving birth.
Advances in RRMS treatments, including B cell therapy, have helped reduce relapses and led to increases in the number of women with RRMS getting pregnant. Women who temporarily stop taking their medication -- sometimes called a drug holiday -- during pregnancy and while breastfeeding may find that their MS gets worse.
But B-cell therapy could have a negative impact on the growing baby, so it’s essential to weigh the benefits and risks of starting or continuing one of these injectable or infusion medications during family planning, pregnancy, and after giving birth.
B-Cell Therapy and Pregnancy
In general, B-cell therapy and other disease-modifying medications for RRMS are not recommended during pregnancy. Your doctor will make recommendations about whether to continue with B-cell injections or infusions during pregnancy based on these factors:
- The severity of your RRMS
- The likelihood you’ll experience a relapse or worsening symptoms if you take a break from medication
- The potential risk to the baby
Since there is much that is unknown about the impact of B-cell therapy during pregnancy, including whether the treatment will harm the baby or pass to a newborn through breastmilk, your doctor may recommend pausing B-cell therapy during pregnancy or switching to another medication with a lower risk.
8 Questions to Ask Your Doctor About B-Cell Therapy and Pregnancy
Family planning is especially important when you have RRMS. Here are some questions to ask your doctor if you receive B cell therapy and plan to become pregnant.
- When should I start planning for pregnancy? It’s never too early to start family planning when you have RRMS. Your goal should be to get your symptoms under control and your disease stabilized before you get pregnant, which will lower your risk of relapse during pregnancy.
- What are some of the risks of receiving B-cell therapy while pregnant? There is a risk that the medication will transfer across the placenta with the highest risks in the second and third trimesters, specifically after 32 weeks.
- Could B-cell therapy harm the baby? The effects of B-cell therapy on a fetus are largely unknown, but the manufacturers of the medications warn that it may harm unborn babies. They recommend that people of childbearing age use birth control while taking B-cell therapy. Your health care provider can provide information about the right birth control for you. You’ll also need to tell your health care provider if you received B-cell therapy during your pregnancy as it will affect when your newborn can receive their vaccines.
- How long before conception should I stop taking the medication? It’s recommended that you continue using birth control for at least 6 months following your last dose of B-cell therapy. Women taking rituximab (Rituxan) should continue taking birth control for at least 12 months after their last treatment.
- What are the potential impacts to my RRMS if I stop treatment during pregnancy? It’s natural to be worried about the impact of stopping B-cell therapy in preparation for pregnancy, but there is some good news: RRMS symptoms were stable among women who received B cell therapy before pregnancy. In fact, one small study found that women who received treatment within 6 months of conception had no relapses before or during pregnancy.
- What if I have a relapse? Your doctor will decide how to manage a relapse based on the severity of the symptoms. For mild RRMS symptoms, you might not need any treatment, and in more severe cases, corticosteroids may be recommended. But it’s essential to talk to your doctor about the risks.
- Can I receive B-cell therapy while breastfeeding? Postpartum RRMS relapses are common. For this reason, your doctor will likely recommend restarting medication within the first month after giving birth to keep symptoms under control and prevent relapses. While more studies are needed to evaluate the likelihood that medication is transferred to infants during breastfeeding, researchers believe that the odds are low. No negative effects on infant health have been reported in breastfeeding infants whose mothers received monoclonal antibodies.
- Is there research being done on the effects of B-cell therapy during pregnancy? Yes. There are several MS pregnancy registries that collect information about the health of pregnant women who take the medication and their babies. Your health care provider can enroll you in the registry. The more you know about the potential impacts of B-cell therapy during pregnancy and the postpartum period, the better you’ll be able to engage in family planning and increase the odds of a safe, relapse-free pregnancy and a healthy baby.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
National Multiple Sclerosis Society. “Women Living With Multiple Sclerosis.”
Annals of Neurology: “B cell therapy for multiple sclerosis: entering an era.”
Clinical & Experimental Neuroimmunology: “Anti-B cell therapies in multiple sclerosis."
Ocrevus: “Infusion Experience.”
Kesimpta.
Rituxan.
Current Treatment Options in Neurology: “Treatment of women with multiple sclerosis planning pregnancy.”
Cleveland Clinic Journal of Medicine: “Reproductive issues and multiple sclerosis: 20 questions.”
Duke Health: “Pregnancy and Multiple Sclerosis: What You Need to Know.”
Neurology Clinical Practice: “Use of B-cell–depleting therapy in women of childbearing potential with multiple sclerosis and neuromyelitis optica spectrum disorder.”
