Abstract

This talk will address management of multiple sclerosis (MS) in the peripartum and postpartum periods. The peripartum period is typically uneventful without any observed increase in maternal or neonatal adverse outcomes in women with MS. Recent studies confirm an increased risk of relapse in the initial postpartum phase (1-3 months). The decision regarding when to restart DMT should be made on an individual basis, taking into account the woman’s preferences regarding breastfeeding and future pregnancies, and her level of MS disease activity. Most women with MS can safely stay off of DMT while breastfeeding. There are multiple benefits of breastfeeding, and exclusive breastfeeding may reduce the risk of postpartum relapse. For women with more aggressive MS, early re-initiation of DMT should be considered. There is emerging evidence that use of certain DMTs may be compatible with breastfeeding. Unmet needs remain in postpartum care of women with MS, including strategies to prevent disease activity in highly active patients in the first months postpartum before full effect of recommenced therapy is realized.