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Atlanta Perinatal Associates ยท Maternal-Fetal Medicine
Multiple Sclerosis
& Pregnancy
Preconception Counseling โ A Partnership for Your Healthiest Pregnancy
Use โ โ arrow keys or the buttons below to navigate
Overview
What We Will Cover Today
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Fertility
MS does not impair your ability to conceive
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Medications
Safe transitions before and during pregnancy
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Timing
Optimizing disease stability before conception
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Postpartum
Protecting you after delivery
Fertility & Genetics
Good News About Fertility & Genetics
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MS does not impair fertility or ovarian reserve
2โ3.5%
Child's risk of MS with one affected parent
~20%
Risk only if both parents are affected
IVF is generally safe. Certain GnRH protocols may carry a small relapse risk โ we will review your specific plan.
Disease Stability
The Ideal Window for Conception
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Now
Review disease activity & MRI
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Months 1โ3
Transition medications safely
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Month 6โ12
Confirm clinical & MRI stability
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Conception
Attempt pregnancy when stable
Goal: At least 6โ12 months of stability before stopping high-efficacy therapies.
Medication Safety
Understanding Your Medication Options
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Generally Safe
Injectable platform therapies may be continued
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Requires Planning
High-efficacy monoclonals โ timing & monitoring needed
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Must Stop Before Pregnancy
Oral agents & teratogens โ washout required
Every plan is individualized. We balance relapse risk against fetal safety.
Medication Guide
Your Medication Safety Reference
| Medication |
Status |
Key Action |
| Glatiramer acetate / Interferon-ฮฒ |
โ Safe |
May continue through conception |
| Natalizumab |
โ Plan |
May continue into 2nd/3rd trimester in high-risk patients |
| Ocrelizumab / Rituximab |
โ Plan |
Contraception 6โ12 months after last dose; monitor infant B-cells |
| Fingolimod / Siponimod |
โ Stop |
2-month washout required; rebound risk if stopped abruptly |
| Teriflunomide |
โ Stop |
Accelerated elimination required; confirm plasma level <0.02 mg/L |
| Cladribine / Alemtuzumab |
โ Complete First |
Complete treatment 4โ6 months before conception; no further dosing needed |
During Pregnancy
What to Expect During Pregnancy
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Relapse Rate Decreases
Especially in the 3rd trimester โ pregnancy has a natural protective effect
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Multidisciplinary Care
Your neurologist and MFM team will coordinate your care throughout pregnancy
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Folic Acid
Start 5 mg daily at least 3 months before conception
Labor & Delivery
Labor & Delivery โ What You Should Know
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MS is not a contraindication to any mode of delivery.
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Vaginal delivery is generally preferred and encouraged.
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All obstetric anesthesia โ including epidurals and spinal blocks โ is safe and does not increase relapse risk.
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Fatigue may affect the second stage of labor; instrumental assistance may occasionally be needed.
Postpartum
The Postpartum Period โ Our Priority
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Relapse risk is highest in the first 3 months postpartum
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Breastfeeding may offer modest protection against early relapses
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We will plan prompt resumption of your DMT after delivery
High-risk patients may benefit from IVIG or early DMT restart. We will individualize your postpartum plan.
Breastfeeding
Breastfeeding & Medications
| Medication |
Breastfeeding |
| Glatiramer acetate / Interferon-ฮฒ |
โ Compatible โ large molecules, low infant absorption |
| Ocrelizumab / Rituximab |
โ Limited Data โ breast milk levels very low; discuss with your team |
| Fingolimod / Teriflunomide |
โ Avoid โ small molecules may transfer into breast milk |
Breastfeeding is encouraged. We will select a medication compatible with nursing whenever possible.
Next Steps
Your Preconception Action Plan
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Start folic acid 5 mg daily โ at least 3 months before trying to conceive.
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Schedule a neurology review to assess disease stability and plan medication transitions.
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Confirm 6โ12 months of clinical and MRI stability before stopping high-efficacy therapies.
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Continue regular MFM visits โ we will co-manage your care with your neurologist.
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Discuss your postpartum plan now, including medication resumption and breastfeeding goals.
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Atlanta Perinatal Associates
You Are Not Alone in This Journey
MS and a healthy pregnancy are not mutually exclusive. With careful planning and a dedicated team, most patients with MS have excellent pregnancy outcomes.
ACOG Practice Bulletin ยท SMFM Guidelines ยท ECTRIMS/EAN Recommendations
Content reviewed for guideline consistency. Slides support physician-led counseling.