Abstract
Chang and colleagues report a case series of neurologic and pregnancy outcomes in 14 pregnancies in 11 adolescent and young adults with pediatric onset multiple sclerosis (MS), with a median age at diagnosis of 16 years and at delivery of 21 years. 1 The majority (79%) were treated with anti-CD20 therapies prior to conception, and MS relapses were rare during pregnancy and postpartum. Obstetric outcomes were generally favorable, although lack of a comparator group precludes conclusions. Furthermore, only 21% of pregnancies appeared to be planned, while the remainder were either documented to be unplanned (43%) or appeared unplanned based on a lack of prior family planning discussions (36%). This highlights the importance of reproductive counseling in all MS patients of childbearing potential, regardless of age.
Findings of this study are largely similar to recent studies in adult-onset MS, where women with MS can have successful pregnancies with a relatively low risk of relapse when disease-modifying therapies (DMTs) are appropriately managed around pregnancy. 2 Relapses in pregnancy and postpartum appear particularly rare in those treated with anti-CD20 therapies such as ocrelizumab before pregnancy. 3
The alarming finding in this study is that up to 79% of pregnancies appeared to be unplanned. Fortunately, despite the majority of pregnancies being unplanned, all appeared to be treated with pregnancy-compatible DMTs which is important for women of reproductive age given the possibility of unintended pregnancy. 2 However, more importantly, contraceptive counseling should be provided to women with MS regardless of age, including adolescents and young adults, given unintended pregnancies should be avoided. Neurologists should highlight that all currently available contraceptive methods are safe and effective for adolescents and young adults 4 and also for the majority of people with MS. 5 Women with MS should be advised to address this topic with their primary care physician or gynecologist, and this topic should be discussed routinely as part of comprehensive MS care. 5
Footnotes
Data Availability Statement
Data sharing is not applicable to this article as no data sets were generated or analyzed during the current study.
Declaration of Conflicting Interests
The author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: K.M.K. has received grants from MS Canada; a contract for a study site from Roche; speaking or consulting fees from Biogen, EMD Serono, Novartis, and Roche; advisory board member for Biogen, EMD Serono, Novartis, and Roche; and scientific advisory committee member for Bristol-Myers Squibb.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
