Abstract

Multiple sclerosis is a neurological disease caused by discrete plaques of demyelination at sites throughout the central nervous system caused by a T-Cell mediated immune response with an unknown trigger. It has a lifetime risk of 1:1000 in the UK, and is twice as prevalent in females with the typical onset being between 20 and 40 years of age, namely the childbearing ages.

There are many disease-modifying therapies used to treat Multiple Sclerosis. However, immunomodulatory and immunosuppressive drugs used at any stage of pregnancy may affect fetus formation and/or development.

Interferons are a group of naturally occurring macromolecules with antiviral, antiproliferative and immunomodulatory properties, and interferon beta is currently the most widely used therapy for multiple sclerosis. However, limited data in primates suggests that interferon beta may be abortifacient. Due to this and due to lack of experience with drug safety, it is usually suggested that either treatment is suspended when a pregnancy is planned, or a critical assessment of the pros and cons of ceasing therapy should be performed.

A literature review of the last ten years identified nine papers, which looked at maternal (relapse rates, mode of delivery) and fetal/neonatal outcomes (spontaneous abortion, pre-term delivery, birth weight, birth defects, still births and developmental milestones) associated with its use in pregnancy.

The literature review highlighted conflicting results, however, on the whole, for most outcomes most studies did not associate IFN beta use during pregnancy with adverse outcomes. Further trials investigating important maternal, fetal and neonatal outcomes are called for.