Table 1.

Pregnancy-Related Aspects of Multiple Sclerosis Disease‐modifying Therapies

DMT	Pre-Pregnancy Washout	Pregnancy	Breastfeeding	Newborn Precautions
Beta interferon	Not required	EMA: May be considered during pregnancy FDA: Use only if the benefit justifies the potential risk to the fetus.	Can be used during breastfeeding
Glatiramer acetate	Not required	Use only if the benefit justifies the potential risk to the fetus	Limited data. Considered safe
Teriflunomide	Accelerated elimination procedure until plasma concentrations are less than 0.02 mg/L	Contraindicated during pregnancy	Contraindicated during breastfeeding	Risk of birth defects
Dimethyl fumarate	Not required	Use only if the benefit justifies the potential risk to the fetus	Limited data. Risks not excluded. Use with caution
Fingolimod	2 months (risk of rebound effect)	Contraindicated during pregnancy	Contraindicated during breastfeeding	Risk of fetal loss and birth defects in animal models
Siponimod	10 days	Contraindicated during pregnancy	Contraindicated during breastfeeding	Risk of fetal loss and birth defects in animal models
Ozanimod	3 months	Contraindicated during pregnancy	Contraindicated during breastfeeding	Risk of fetal loss and birth defects in animal models
Natalizumab	Not required (risk of rebound effect)	Use only if the benefit justifies the potential risk to the fetus at least until first trimester or 30–34 weeks	EMA: Contraindicated during breastfeeding FDA: Use only if the benefit justifies the potential risk to the infant	Risk of hematological abnormalities in infants exposed in the third trimester
Alemtuzumab	4 months after last dose	Use only if the benefit justifies the potential risk to the fetus	EMA: Discontinue during each course and for 4 months following the last infusion. Benefits may outweigh the risks for the infant FDA: Discontinue either alemtuzumab or breastfeeding	Untreated maternal hypothyroidism increases the risk for miscarriage and may have effects on the fetus. Risk of neonatal Graves` disease in mothers with Graves` disease
Ocrelizumab	EMA: 12 months FDA: 6 months	Use only if the benefit justifies the potential risk to the fetus	EMA: Contraindicated during breastfeeding FDA: Use only if benefit justifies the potential risk to the infant	Risk of B-cell depletion after intrauterine or breast milk exposure
Cladribine	6 months after last dose	Contraindicated during pregnancy	Breastfeeding contraindicated during treatment and for 1 week after the last dose	Risk of congenital anomalies
Ofatumumab271	6 months after last dose	Use only if the benefit justifies the potential risk to the fetus	Use only if benefit justifies the potential risk to the infant.	Risk of B-cell depletion after intrauterine or breast milk exposure
Ponesimod272	1 week after last dose	Contraindicated during pregnancy	Contraindicated during breastfeeding	Risk of fetal loss and birth defects in animal models

Abbreviations: DMT, disease-modifying therapy; EMA, European Medicines Agency; FDA, United States Food and Drug Administration.