Serum neurofilament light (NfL) levels rose in women with multiple sclerosis (MS) during pregnancy and postpartum periods when no disease-modifying treatment (DMT) was used, researchers reported.

This rise in NfL, a measure of axonal injury, was independent of MS relapses, suggesting increased subclinical disease activity during this time, said Özgür Yaldizli, MD, of University of Basel in Switzerland, at a late-breaking session of MS Virtual 2020, the joint ACTRIMS-ECTRIMS meeting.

There’s an urgent need to identify patients with high disease activity during pregnancy, Yaldizli noted.

“Neurofilament light may qualify as a sensitive and minimally invasive measure of disease activity during pregnancy,” he told MedPage Today. “We think that strategies to continue DMT during pregnancy, at least in selected patient groups, are warranted.”

Pregnancies among women with MS have risen in the U.S. Research has shown that relapse rates tend to decline during pregnancy, especially in the third trimester, and increase during the first 3 months postpartum before returning to pre-pregnancy rates.

“According to natural history cohorts, about one-third of pregnant MS women experience a relapse within 3 months postpartum,” Yaldizli said. “DMTs can reduce the risk of relapses, but have potential side effects for the fetus and woman.”

One of the dilemmas neurologists face with MS patients who want to become pregnant is what to do about disease-modifying therapy, noted Jeffrey Cohen, MD, of the Cleveland Clinic in Ohio, who wasn’t involved with the study.
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