This article will discuss how pregnancy can be managed in patients with MS.
MS and Pregnancy: Progression
While pregnancy rates in the United States have been declining since 1990, pregnancy in women with MS has actually increased. This may be due to a greater understanding of the effects of pregnancy for women with MS.
Previously, there were fears about how a pregnancy would affect both the progression of the disease as well as the unborn child. That is no longer the case, as newer research indicates that fertility is not impaired by the disease, and pregnancy is possible and safe.
The majority of women with MS can safely become pregnant and have a healthy baby without affecting their own health, the baby’s health, or impacting the progression of their disease.
Before Pregnancy
The diagnosis of MS often occurs between the ages of 20 to 40, during prime childbearing years when women may consider starting a family.
When considering becoming pregnant, women with MS may have concerns about fertility. Previous concerns that fertility rates were lower in women with MS have proven not to be the case.
Symptoms
Although it is not always possible to plan a pregnancy, one way of reducing MS symptoms during pregnancy is to plan to become pregnant when MS is at its lowest activity. This means when the disease is stable and well-managed with effective treatments.
Treatment
Women with MS are likely taking medication for treatment prior to getting pregnant. These include disease-modifying therapies, or DMTs.
Women with MS are advised to stop taking these medications prior to trying to conceive. Medications for MS (such as DMTs) are not safe to take while pregnant or breastfeeding.
There are currently no treatments for MS that are approved for use during pregnancy. Women with MS who become pregnant should discuss treatment changes with their physicians.
Risks
Multiple studies indicate that having MS does not appear to impact a woman’s ability to conceive and carry a baby to term. However, there are a few issues unique to MS to consider when planning a pregnancy:
Fertility treatment: Women who have trouble conceiving may consider fertility treatments, like IVF, to help them become pregnant. However, some types of fertility treatment may increase the risk of relapse. Increases in other MS symptoms from fertility treatments have also been studied. Passing MS to the child: The risk of passing MS onto a child is a common concern for any parent with the disease. For a woman with MS, the risk of passing MS to her child is 2% to 2. 5%. The risk jumps up to 30% if both parents have MS. Vitamin D: There’s a connection between low vitamin D levels and increased MS disease activity. Pregnant women with MS should discuss taking a vitamin D supplement with their physician, both to improve their health and reduce the chances of passing MS onto their children.
During Pregnancy
Pregnancy leads to many changes to a woman’s body. For a woman with MS, pregnancy may actually help with relapses.
Symptoms
Pregnancy appears to reduce the MS relapse rate, particularly in the last trimester. The increase in hormones such as estrogen activate the T helper cells to have anti-inflammatory effects instead of their usual pro-inflammatory effects. After the baby is delivered, this change reverts back to normal.
Another recent study indicates that pregnancy and childbirth can delay the start of MS symptoms by up to three years.
Treatment
In most cases, DMTs will be discontinued during pregnancy due to the risks of birth defects and complications. Women should talk to their physician about the safety of continuing their specific MS treatment during pregnancy.
Women with MS who do experience relapses while pregnant may be prescribed a corticosteroid. These medications have been determined to be safe during pregnancy.
Risks
Having MS does not necessarily mean that your pregnancy will be high risk. However, women will need to consider a few issues during pregnancy, including:
Gestational size and birth weight: The baby may tend toward being smaller for its gestational age. Additional monitoring through ultrasounds may be ordered if this becomes an issue, to track the baby’s growth and development. Labor and delivery: Women with MS may face issues with feeling the start of labor and pushing during labor. This can occur when there is nerve damage in the pelvic floor. Assistance during delivery may be helpful if this is an issue. Cesarean birth or c-section: With this surgery, the baby is delivered through a cut in the abdomen and uterus. Women with MS have a slightly higher rate of having c-sections, due to muscular or nerve issues. Flares following delivery: Women with MS are at higher risk of relapse in the first three months following delivery. This may be due to the dramatic change in hormones in the postpartum period. Pain relief: To manage the pain of delivery, both epidural and and spinal anesthesia are safe for women with MS and do not appear to cause flares or relapses.
After Pregnancy
Bringing home a baby is an exciting time for most mothers. However, for mothers with MS, there are some additional issues to consider when breastfeeding and resuming medications.
Symptoms
While pregnancy may offer a break from typical MS symptoms, symptoms may return around three months after the birth. The three months following a delivery are considered a high-risk period for increased MS disease activity, which may impact treatment options and decisions.
Treatment
For women with MS who have a higher risk of postpartum relapse, especially in the three months following delivery, quickly resuming DMT medications is recommended, unless they are breastfeeding.
Breastfeeding is a particular concern for women with MS, due to how medications may be passed through breastmilk. Currently, there is limited information on the transfer of DMTs in breastmilk and the safety of using DMTs while breastfeeding.
While it has not been confirmed, researchers consider it highly likely that DMTs are transferred through breastmilk. Therefore, physicians will likely recommend that mothers not take DMTs while breastfeeding.
Risks
MS relapse is always a risk following pregnancy. In fact, as noted above, the risk increases significantly in the first three months following childbirth. Discuss MS-related pregnancy issues, including when to resume DMTs and how that may impact breastfeeding, with your physician.
Breastfeeding is recommended for women with MS, as it has been shown to reduce the risk of relapse.
Perinatal and Postpartum Depression
Perinatal depression is defined as depression that occurs during pregnancy or during the first year after childbirth.
People with MS are already at risk for depression, due to the psychological impact of dealing with a chronic illness. Women with MS have a higher likelihood of developing perinatal depression.
Women who are diagnosed with MS during the postpartum period report the highest levels of depression, while women who are diagnosed before pregnancy have similar rates of depression as women without MS.
A Word From Verywell
A safe pregnancy is possible for women with MS, though it will take a little more planning and consideration. Managing your disease will be challenging during this period. Make sure you discuss the potential risks and changes to your treatment plan with your physician before you plan to conceive.
