Managing MS and Related Neuroimmunological Disorders in Pregnancy – New Specialized Clinic at UPMC in Development
July 29, 2025
Multiple sclerosis (MS) is a complex autoimmune neuroinflammatory disease that presents unique challenges in pregnancy. Several decades ago, before modern disease-modifying therapies (DMTs) were widely available, women with MS were often discouraged from pregnancy because of concerns about disease progression and limited treatment-safety data. Contemporary evidence and expanded therapeutic options have substantially altered this view.
Ingrid Loma-Miller, MD, assistant professor of Neurology at the University of Pittsburgh School of Medicine and assistant chief of the Division of Neuroimmunology/MS, is spearheading the development of an MS and Neuroimmunology Pregnancy Clinic at the UPMC Multiple Sclerosis Center. The planned clinic will offer individualized care for women with MS, Neuromyelitis Optica Spectrum Disorder (NMOSD), Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD), and related immune-mediated conditions who are pregnant or planning pregnancy.
Working closely with Neuroimmunology/MS division chief, Jenny Linnoila, MD, PhD, and with Eliza Miller, MD, MS, associate professor of Neurology, UPMC Endowed Chair in Women’s Brain Health, and the new division chief for Women’s Neurology, Dr. Loma-Miller aims to launch the clinic by the end of the year, integrating multidisciplinary expertise, evidence-based treatment strategies, and a strong emphasis on health-equity principles.
Developing the MS and Neuroimmunology Pregnancy Clinic at UPMC
Dr. Loma-Miller is establishing the clinic to address the need for evidence-based, individualized care throughout pre-conception counseling, pregnancy, and the postpartum period. Multidisciplinary specialists, including neurology, maternal-fetal medicine, neuro-urology, and neuro-infectious disease, will collaborate to design treatment plans that balance disease control with maternal and fetal safety.
“We now have the data and experience to guide patients through pregnancy while maintaining MS stability or quiescence,” says Dr. Loma-Miller.
The clinic’s scope intentionally extends beyond MS to encompass NMOSD and MOGAD, disorders for which pregnancy-specific data remain sparse. By consolidating expertise in one setting, the program seeks to provide clear guidance where current literature is limited.
Changing Perspectives on Autoimmune Neuroinflammatory Disease and Pregnancy
For many years, MS was viewed as a barrier to pregnancy. Advances in DMTs and accumulating outcome data have shifted that perspective. For several years now we know that relapse rates typically decline during pregnancy, particularly in the second and third trimesters, likely reflecting pregnancy-associated immunomodulation
However, the literature is clear that the postpartum period of the first three to six months carries an increased risk of relapse for patients
“We know the postpartum period is a vulnerable time for relapse, so we work closely with patients to develop strategies for treatment resumption while considering breastfeeding goals,” says Dr. Loma-Miller. “Our primary goal is avoiding a relapse but doing so requires a nuanced approach that takes into consideration the patient’s goals of care and overall health.”
These insights are equally relevant for NMOSD and MOGAD, where pregnancy guidance is still emerging and where early data suggest distinct relapse patterns.
Individualized Treatment Planning
Treatment planning begins before conception. DMT regimens are tailored to disease activity, individual risk, and pregnancy timing. Carefully timed infusions of B-cell–depleting agents or extended-interval natalizumab dosing may maintain disease control while minimizing fetal exposure.
“Each patient’s case is different, and the treatment approach needs to reflect that,” says Dr. Loma-Miller.
For NMOSD and MOGAD, the team coordinates with immunology and maternal-fetal medicine specialists to weigh the benefits of therapies such as rituximab, eculizumab, or inebilizumab, adjusting schedules to accommodate pregnancy plans.
Research and Quality-Improvement Initiatives
The clinic’s research agenda emphasizes:
- Long-term maternal and fetal safety of DMT exposure during pregnancy and lactation.
- Postpartum relapse-risk mitigation across MS, NMOSD, and MOGAD.
- Real-world effectiveness of emerging treatment-timing algorithms in diverse patient populations.
- Industry-sponsored and collaborative clinical trials that generate prospective safety and outcome data.
“There are still many unanswered questions about how MS therapies interact with pregnancy and lactation,” says Dr. Loma-Miller. “Our research is focused on providing the data we need to improve patient care while maintaining safety.”
A parallel quality-improvement initiative will examine social determinants of health (SDOH), including access to specialty care, insurance status, and transportation, and how these factors influence pregnancy outcomes for women with autoimmune neuroinflammatory diseases.
Education, Outreach, and Health Equity
Dr. Loma-Miller works with the National MS Society and similar organizations to update clinician and patient education on pregnancy in MS, NMOSD, and MOGAD. A key objective is reducing disparities by ensuring that women of child-bearing age receive accurate information about treatment safety and fertility planning.
“One of the biggest challenges is outdated information,” says Dr. Loma-Miller. “Our job is to provide the most up-to-date guidance so patients can make the best choices for their health and goals for care, and for their families.”
Redefining Care for Women with Autoimmune Neuroinflammatory Disorders
Through specialized clinical services, focused research, and a commitment to health equity, the forthcoming clinic is poised to recast how MS and related disorders are managed before, during, and after pregnancy.
“Every patient’s journey with MS is different,” says Dr. Loma-Miller. “But with the right guidance, we can help ensure the best possible outcomes for the mother and her baby.”
Patient Referrals
For more information, visit the UPMC Multiple Sclerosis Center or contact the center for referrals and consultation at 412-641-6600.
More About
