Anti-CD20 Therapy Safety and Outcomes in Pregnancy

Recent clinical reviews and real-world registry data indicate that anti-CD20 monoclonal antibodies are generally safe for women of reproductive age managing multiple sclerosis and other autoimmune conditions. Because these drugs do not significantly cross the placenta until the second trimester, exposure during the preconception period or early pregnancy does not appear to increase the risk of congenital malformations. While infants exposed later in gestation may experience transient B-cell depletion, they typically recover within six months without a heightened risk of serious infection. Research suggests that spontaneous abortion rates remain within the expected range for the general population, although some data show a slight increase in "exposed" pregnancies. Consequently, experts are moving toward more flexible washout periods to ensure continuous maternal disease control while monitoring newborns for immune recovery. To maintain infant safety, medical guidelines recommend deferring live vaccines for at least six months following late-pregnancy exposure.