A 29-year-old woman with relapsing-remitting MS (2 relapses in past year, one new T2 lesion on MRI) is being considered for disease-modifying therapy. She is pregnant and planning to breastfeed. Which DMT approach is most appropriate according to ECTRIMS/EAN 2023 guidelines?
- A Natalizumab throughout pregnancy — safest high-efficacy agent in this setting
- B Glatiramer acetate can be continued throughout pregnancy and breastfeeding based on current safety data ✓
- C Stop all DMTs at conception and resume after breastfeeding is complete
- D Teriflunomide — safe in pregnancy as teratogenicity is overstated in older literature
Explanation
Glatiramer acetate (GA, Copaxone) has the most robust pregnancy safety data among MS DMTs; it is FDA Pregnancy Category B and is considered compatible with both pregnancy and breastfeeding. Interferon-beta also has relatively favourable data but is generally stopped in pregnancy. Natalizumab is used with caution — extended dosing intervals near term are sometimes employed but it is not universally recommended throughout pregnancy. Teriflunomide is strictly contraindicated in pregnancy (teratogenic, Category X). Stopping all DMTs in active relapsing MS risks severe postpartum rebound.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.