Pregnancy and Delivery While on Natalizumabi: A Case Study

Background: Multiple sclerosis (MS) affects more women than men and is often diagnosed during childbearing years(1). Pregnancy in MS is generally found to be protective for most women (2); however, those with more aggressive MS may still experience relapses during pregnancy and benefit from treatment. There is insufficient evidence to determine the safety of using MS disease modifying therapies (DMTs) during pregnancy(1). This research gap is potentially detrimental for women with MS, especially those with aggressive courses, as stopping DMTs while trying to get pregnant may result in accumulated disability.

Objectives: To present a case study of a 39 year old African American MS patient, with severe disease, who voluntarily chose to stay on natalizumab for the duration of her pregnancy after failing prior DMTs.

Methods: After inadequate response with prior DMTs, the patient started natalizumab in August 2009 and was stable on treatment before her first pregnancy in November 2010. Patient was advised to discontinue natalizumab. Seven weeks after her last natalizumab infusion, patient experienced a severe relapse towards the end of her first trimester, followed by a miscarriage at 16 weeks gestation.  Patient conceived again in early August 2016 while on natalizumab intravenously every 4 weeks and was again advised to discontinue treatment. Patient voluntarily decided to continue with treatment for the duration of her pregnancy after understanding the risks.

Results: A thoroughly medical history will be presented, highlighting her past and present neurological symptoms, DMTs, laboratory results, and MS disease course. Additionally, the medical and neurological status of the infant, delivered on 12/12/16 at 25 weeks and 5 days gestation will be presented.

Conclusions: Until detailed guidelines for use of DMTs during pregnancy are suggested, learning about individual case studies may help both clinicians and patients decide whether or not to continue natalizumab during pregnancy.

References:

1. Alroughani, R., Altintas, A., Al Jumah, M., Sahraian, M., Alsharoqi, I., AlTahan, A., ... & Grigoriadis, N. (2016). Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks. Multiple Sclerosis International, 2016.

2. Gilmore, W., & Airas, L. (2016). Successive pregnancies in multiple sclerosis.