b'Medicine and ResearchPPrreeggnnaannccyyaannddBBrreeaassttffeeeeddiinnggwwiitthhMMSSBy Cherie BinnsDuring the 2020 annual meeting of the (Tysabri) are linked to a small increase inConsortium of Multiple Sclerosis Centers, there the incidence of miscarriage and that drugwere presentations relating to family planning, needs to be stopped by the last trimester ofpregnancy and lactation (breastfeeding) in pregnancy.Teriunomide(Aubagio)haspersons living with multiple sclerosis. Here is beenassociatedwithmiscarriagesandwhat we learned: birth defects in the animal model of MS.M This is also true when a man with MS is onMeeddiiccaattiioonnSSaaffeettyy this medication and plans to father a child Ifbirthcontrolpillsareusedtoprevent as the drug is found in sperm. pregnancy,theyshouldbestoppedandCladribine (Mavenclad) taken two monthsmenstrual cycle normalized prior to stopping prior to conception gives an additional tena disease-modifying therapy and planning months of protection from increased diseasefor conception. activity so may be a drug to consider when None of the current oral therapies are deemed planning to get pregnant. This drug maysafe for the fetus during pregnancy or the also be suggested as a full course over a 13-baby during the time of breastfeeding. month period prior to planning to conceiveFingolimod (Gilenya) and Siponimod (Mayzent) as it is thought to incur a long-term protectionshould be stopped at least two months prior against relapse so a woman would not needto conception. Because rebound relapse rates a DMT during pregnancy or lactation if thisare high with these drugs, it is recommended drug is completed prior to pregnancy.to transition to one of the injectable interferonsIt is suggested both oral prednisone andorglatirameracetateimmediatelywhen intravenous Solumedrol are safe in thecoming o these oral medications.management of a relapse during pregnancy The injectable drugs are safe to use during after the first trimester as well as duringpregnancyandbreastfeeding.Itisalso lactation. Dexamethasone, however, is notthought that every six-month infusions of a safe steroid for use during these times inOcrelizumab or Rituximab are a reasonable a womans reproductive life span. therapytotransitiontofromtheseoralIt is safe to have an MRI, if needed, duringmedications.pregnancy but gadolinium or a dye to Pregnancies associated with Natalizumab enhance lesions on MRI is not safe to use.msfocusmagazine.org 40'