Many women with multiple sclerosis (MS) are diagnosed during their child-bearing years, when they are thinking of starting or expanding their families. Many years ago it was believed that pregnancy could make MS worse and that mothers with the disorder wouldn't be able to care for children. Today we know that pregnancy can actually be protective for women with MS, possibly because of a less-active immune system and an increase in natural steroids during pregnancy. In addition, current therapies give women a good chance to stay more physically active and help equip them for the demands of motherhood.
A recent study helped confirm the good news about MS and pregnancy. As reported in the November 2009 online edition of Neurology, pregnant women with MS were found to be only a little more likely to deliver babies by cesarean section than women who don't have the disorder. The study also showed that women with MS are no more likely to have other problems with pregnancy, such as high blood pressure and premature rupture of membranes, than women in the general population. In short, women in the study were not shown to have an increased risk of most pregnancy complications.
The MS care team at Virginia Mason is experienced and knowledgeable in the care of pregnancy and MS. Every woman begins a plan of care designed to address every stage of pregnancy, while coordinating her treatment with her ongoing obstetrical care. Expertise and support are available throughout the pregnancy on everything from the management of MS symptoms to what to expect during and after the birth.
Download the Virginia Mason printer-friendly hand-out: Pregnancy and MS.
1. Are fertility and pregnancy complications more likely for women with MS?
No, there is no evidence that MS impairs fertility or is linked to problems like miscarriage, ectopic pregnancy, preterm birth, stillbirth or congenital abnormalities. One study has shown that women with MS are only slightly more likely to deliver babies by cesarean section. In other words, women with MS are as likely to have a normal, healthy pregnancy as other women in their age range.
2. Will MS symptoms get worse during pregnancy?
No, in fact some women experience complete relief of their MS symptoms during pregnancy. For others, MS relapses tend to decrease significantly, especially in the second and third trimesters.
3. What about MS drug therapies during pregnancy?
Women on MS treatment are advised to stop the medication while trying to conceive and throughout pregnancy. Be sure to discuss any other medications taken for MS symptoms with a physician as some may not be safe during conception or pregnancy.
Because MS therapies should be stopped before actively trying to become pregnant, some women will be off the medication for a long period of time. It may be helpful to talk with a doctor about ways to increase the chances of conceiving quickly, or to seek help if there is a delay in getting pregnant.
4. What about using anesthesia during delivery?
A recent study showed that women who had epidurals did not have a higher number of MS relapses after delivery than those who did not have the procedure. However women should discuss anesthesia choices with their neurologist and obstetrician sometime after the second trimester to ensure a plan is in place.
5. Are relapses common after the baby is born?
There is no way to predict if a woman with MS will have a relapse after birth, or if she does, what the symptoms might be. Some evidence suggests the risk of relapse in the first six months after birth is between 20 percent and 40 percent. Having a plan to receive help should a relapse occur is essential to prevent the stress of scrambling for help unexpectedly.
6. Can a woman with MS breastfeed?
Having MS doesn't itself pose any obstacle to breastfeeding. However breastfeeding while taking MS medications is not recommended, since the drugs may pass into breast milk. Some women base how long they breastfeed on how long they are willing to forego therapy. Virginia Mason's MS care team may recommend an MRI for women who have been breastfeeding for more than six months at the time of resuming treatment.
7. Does a mother pass MS to her baby?
MS is not a directly inherited disease, however it appears that there is about a 1 percent to 3 percent chance of a child born to a parent with MS developing the disorder themselves (compared to a risk in the general population of one-tenth of 1 percent). This slightly increased risk could be due to passing on a genetic susceptibility to an unknown environmental trigger of the disease.
In fact, studies of identical twins show that heredity cannot be the only factor involved. An identical twin has only a 30 percent chance of developing multiple sclerosis even when his or her twin already has the disease.