UK consensus on pregnancy in multiple sclerosis: An update to ‘Association of British Neurologists’ guidance

BACKGROUND: The first Association of British Neurologists (ABN) UK multiple sclerosis (MS) pregnancy guidelines were published in 2019. Along with new disease-modifying treatments, significant new data have since become available, resulting in label changes and recognition of class effects. Alongside this, there has been increasing recognition of the importance of family planning considerations in treatment paradigms in MS. METHODS: We set out to update the ABN UK MS Pregnancy guidance with a systematic literature search, with updated guidance informed by multidisciplinary input from across neurology, obstetric medicine, pharmacy and specialist nurses.Guidance:Key updates include consideration of disease-modifying therapy mechanism and durability of action when discussing treatment approaches around pregnancy, alongside considering the impact of treatment withdrawal on relapses during pregnancy and in the postpartum period. Monoclonal antibody transfer into breast milk is generally accepted to be low, and so treatment during lactation can be considered. Active discussion around vaccination strategies during pregnancy and of the neonate is required, with vaccines generally considered safe. With active treatment strategies that take these factors into account, women can be reassured regarding disease control during pregnancy. CONCLUSION: Data sources remain limited, and further dedicated real-world studies that capture the full range of outcomes required to inform risk-benefit discussions are needed. These require collaboration and infrastructure to support the delivery of high-quality care to all women with MS considering pregnancy.