期刊
NEUROLOGY
卷 79, 期 11, 页码 1130-1135出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3182698c64
关键词
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资金
- University of British Columbia
- Canadian Institutes of Health Research
- Multiple Sclerosis Society of Canada
- Albert and Mary Steiner Summer Research Award
- Canadian Institutes for Health Research (Professional Student Research Award)
- MS Society of Canada Scientific Research Foundation
- CIHR
- Michael Smith Foundation for Health Research Scholar
- Canada Research Chair for Neuroepidemiology and Multiple Sclerosis
- US National Multiple Sclerosis Society
- UK MS Trust
Objective: To systematically review the literature regarding safety of disease-modifying drug (DMD) use during pregnancy on perinatal and developmental outcomes in offspring of patients with multiple sclerosis (MS). Methods: A PubMed and EMBASE search up to February 2012 was conducted with a manual search of references from relevant articles. Selected studies were evaluated using internationally accepted criteria. Results: Fifteen studies identified 761 interferon beta-, 97 glatiramer acetate-, and 35 natalizumab-exposed pregnancies. Study quality ranged from poor to good; no study was rated excellent. Small sample sizes limited most studies. Compared with data for unexposed pregnancies, fair- to good-quality prospective cohort studies reported that interferon beta exposure was associated with lower mean birth weight, shorter mean birth length, and preterm birth (<37 weeks), but not low birth weight (<2,500 g), cesarean delivery, congenital anomaly (including malformation), or spontaneous abortion. Fewer studies of fair quality were available for glatiramer acetate and natalizumab. Glatiramer acetate exposure was not associated with lower mean birth weight, congenital anomaly, preterm birth, or spontaneous abortion. Natalizumab exposure did not appear to be associated with shorter mean birth length, lower mean birth weight, or lower mean gestational age. No studies examined mitoxantrone or fingolimod exposure. One study of paternal DMD use during conception found no effect on gestational age or birth weight. Few studies examined longer-term developmental outcomes. Conclusion: Further studies are needed to determine the potential risks associated with preconceptional and in utero DMD exposure in patients with MS. Discontinuation of DMDs before conception is still recommended. Neurology (R) 2012;79:1130-1135
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