Contributions
Abstract: 4
Type: Educational Session
Abstract Category: N/A
In addition to disease modifying therapy, symptomatic treatment adds a complexity to the disease management of women with multiple sclerosis (MS) during pregnancy and lactation, as it can affect patient quality of life. In raising awareness of comorbidities and MS related symptoms in clinical practice, knowledge about possibilities and risks of symptom management during pregnancy and lactation represent an unmet need.
In premarketing clinical trials, ethical issues rule out safety of medication for the pregnant women and the unborn child. Some information about potential harmful foetal effect is obtained from reproductive animal studies but their predictive value is unknown and the interpretation of these is rather complex. Therefore, most evidence regarding adverse foetal effects of different drugs derives from post marketing experience.
An excessive fear of drug-induced malformations of treating pregnant women with medication can cause insufficient treatment, unnecessary discomfort for the pregnant or abortion of completely normal children.
Treatment with drugs that may cause malformations before recognized pregnancy will very rarely be an indication of abortion alone. During pregnancy, some chronic and acute disorders needs pharmacological treatment in women with MS, as severe spasticity, pain, seizures, severe depression, thyroid disease etc. Pregnancy can increase spasticity in patients with existing reduced mobility due to their increased weight, worsening the disability. Urinary tract infections are more common in pregnancy, and the risk is higher in MS patients with pre-existing neuropathic bladder.
Medical treatment in pregnant women requires a well-founded indication and dosage has a great importance. However, new drugs should be avoided due to lack of evidence regarding the risk of foetus, treatment in the first trimester should be avoided as the risk of organ damage is greatest during this period and combination therapy should be avoided.
Although most drugs are excreted in the milk, rare that more than 1-2% of the dose given to the mother occurs in the milk and such a low concentration is irrelevant to the healthy child. Each case should be carefully considered before making a clinical recommendation.
Use of symptomatic medication in pregnancy should be discussed prior to pregnancy, all symptoms should be taken into consideration in assessment of the disease status, and discontinuation of all medication if dispensable must be recommended.
Disclosure: Melinda Magyari: has served on scientific advisory board for Biogen, Sanofi, Teva, Roche, Novartis, Merck, has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi, Genzyme, has received support for congress participation from Biogen, Genzyme, Teva, Roche.
Abstract: 4
Type: Educational Session
Abstract Category: N/A
In addition to disease modifying therapy, symptomatic treatment adds a complexity to the disease management of women with multiple sclerosis (MS) during pregnancy and lactation, as it can affect patient quality of life. In raising awareness of comorbidities and MS related symptoms in clinical practice, knowledge about possibilities and risks of symptom management during pregnancy and lactation represent an unmet need.
In premarketing clinical trials, ethical issues rule out safety of medication for the pregnant women and the unborn child. Some information about potential harmful foetal effect is obtained from reproductive animal studies but their predictive value is unknown and the interpretation of these is rather complex. Therefore, most evidence regarding adverse foetal effects of different drugs derives from post marketing experience.
An excessive fear of drug-induced malformations of treating pregnant women with medication can cause insufficient treatment, unnecessary discomfort for the pregnant or abortion of completely normal children.
Treatment with drugs that may cause malformations before recognized pregnancy will very rarely be an indication of abortion alone. During pregnancy, some chronic and acute disorders needs pharmacological treatment in women with MS, as severe spasticity, pain, seizures, severe depression, thyroid disease etc. Pregnancy can increase spasticity in patients with existing reduced mobility due to their increased weight, worsening the disability. Urinary tract infections are more common in pregnancy, and the risk is higher in MS patients with pre-existing neuropathic bladder.
Medical treatment in pregnant women requires a well-founded indication and dosage has a great importance. However, new drugs should be avoided due to lack of evidence regarding the risk of foetus, treatment in the first trimester should be avoided as the risk of organ damage is greatest during this period and combination therapy should be avoided.
Although most drugs are excreted in the milk, rare that more than 1-2% of the dose given to the mother occurs in the milk and such a low concentration is irrelevant to the healthy child. Each case should be carefully considered before making a clinical recommendation.
Use of symptomatic medication in pregnancy should be discussed prior to pregnancy, all symptoms should be taken into consideration in assessment of the disease status, and discontinuation of all medication if dispensable must be recommended.
Disclosure: Melinda Magyari: has served on scientific advisory board for Biogen, Sanofi, Teva, Roche, Novartis, Merck, has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi, Genzyme, has received support for congress participation from Biogen, Genzyme, Teva, Roche.