Questions about Pregnancy in Multiple Sclerosis

Ten Questions When Considering Pregnancy with MS

For many women with multiple sclerosis, the diagnosis comes right at the time when they are thinking of starting (or expanding) their family. Years ago, women with MS were discouraged from having children, as doctors believed that pregnancy made MS worse and that they would not be able to care for young children. The picture is much brighter today.

Studies have shown that pregnancy reduces a woman's chance of having an MS relapse, especially during the third trimester. In addition, the current therapies give women a much better chance of staying physically active and capable of caring for newborns, chasing toddlers, and even coaching the soccer team someday.

1
Should I Have a Baby?

Pregnant woman on sofa reading magazine.
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Of course, that is a decision to be made by each woman based on many factors. However, women with MS may face special challenges related to their physical condition and the realities of caring for small children.

  • Talk to friends with children and spend time with people with small babies to get a realistic picture of what it's like to care for babies and children of different ages.
  • Discuss things with your partner and support system.
  • Ask yourself some difficult questions. Will I need additional help? Can I afford to hire someone or rely on others for this help?

2
Are Pregnancy Complications More Likely if I Have MS?

No. There is no evidence that MS is linked to any problems with pregnancy, such as miscarriage, ectopic pregnancy, preterm births or stillbirth. There is also no link to fertility problems or congenital abnormalities. In other words, you are as likely to have a normal, healthy pregnancy as any other woman in your age range.

3
Will My MS Symptoms Get Worse During Pregnancy?

No. Most women experience relief from most or even all of their MS symptoms during pregnancy. This is likely because pregnancy itself reduces immune activity and levels of natural steroids are higher in pregnant women.

That being said, pregnancy does come with its own symptoms and discomforts, which may aggravate preexisting MS problems like bladder problems or fatigue.

4
Can I Take MS Disease-Modifying Medication During Pregnancy?

If you are on MS treatment, you will probably be advised to stop while trying to conceive and throughout pregnancy.

  • The interferons (Avonex, Betaseron, Rebif, Plegridy, and Extavia) are all pregnancy category C drugs, meaning they caused some harm to fetuses in animal studies, but the effect in humans is unknown.
  • Glatiramer acetate (Copaxone) is a pregnancy category B drug, meaning it did not cause harm to fetuses in animal studies, but no adequate human studies have been done.
  • Tysabri (natalizumab) and Lemtrada (alemtuzumab) are infusion MS treatments (given through the vein) that are pregnancy category C drugs.
  • Mitoxantrone is also an infused MS medication, but is pregnancy category D. This means that studies demonstrate fetal harm, but the benefits of taking the drug may outweightthe risks in certain individuals. 
  • Aubagio (teriflunomide) is an oral pregnancy category X drug. This means it's contraindicated during pregnancy or when attempting pregnancy, as studies have demonstrated fetal harm, and the risks of the medication outweigh any benefit.
  • Gilyena (fingolimod) and Tecfidera (dimethyl fumarate) are both oral MS medications that are pregnancy category C.

You will also need to discuss any medications you are taking for MS symptoms, as some are considered safe and some are not.

5
What If It Takes a Long Time to Get Pregnant?

Usually women stop MS therapy for months before trying to conceive, so the medication has time to clear. Your doctor can advise you on what period of time is safe for you. Once this period is over, you should try to become pregnant as quickly as possible because you will be off medication during this time.

It's reasonable to discuss with your OB/GYN about what you can do to increase your chances of conceiving quickly, including monitoring ovulation and timing intercourse. 

6
What is the Role of My Neurologist?

Your neurologist will have an opinion about therapy options and monitoring you while you are trying to conceive and during pregnancy. He may also have certain precautions that he will take to prevent a relapse after you have your baby. Studies have shown that a dose of intravenous immunoglobulin (IVIG) given to women immediately after childbirth significantly reduces the chances of postpartum relapse. Some neurologists prescribe one or several doses of Solu-Medrol (intravenous corticosteroids) for this purpose, while others prefer the watch and wait approach. 

7
Can I Use Have an Epidural or Spinal Anesthesia During Delivery?

Some neurologists advise against using spinal anesthesia or a spinal “block” as they believe that there is a greater risk of complications. However, in a recent study, women who had epidurals (different than a spinal block) did not have a higher number of relapses than those who did not.

The choice of anesthesia should be discussed with your neurologist, obstetrician, and anesthesiologist early in the third trimester. This way, there is a plan in place that everyone (including you) are comfortable with when the time comes. 

8
Will I Have a Relapse After My Baby is Born?

Your risk of a relapse in the first six months after having your baby is about 20 to 40 percent. It's important that you have a plan in place in case you have a relapse, including someone to take you to the doctor and to help you take care of your baby and yourself. As with all things in MS, no one can predict if you will have a relapse, and if you do, what symptoms you will have.

9
Can I Breastfeed My Baby?

MS itself does not pose any obstacles to breastfeeding. However, since it's not known with certainty whether the disease-modifying therapies pass into breast milk, most physicians advise not resuming these therapies until after you have finished breastfeeding. Many women with MS choose to resume therapy immediately and feed their babies formula, so that they can try to reduce the chances of a relapse. Others breastfeed for a period up to three or four months to give their infants the benefits of breast milk during this time. Only you can decide what is the right decision for you and your baby.

10
Will My Baby Have MS?

MS is not directly inherited The evidence shows that there is about a 2 to 5 percent chance of a child born to a parent with MS developing MS themselves. There are currently no genetic or prenatal tests, or even tests on your newborn, that can determine the likelihood of this happening.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

Sources

Achiron, A., et al. (2004). Effect of intravenous immunoglobulin treatment on pregnancy and postpartum-related relapses in multiple sclerosis.Journal of Neurology, Sep;251(9):1133-7.

Haas, J. (2000). High dose IVIG in the postpartum period for prevention of exacerbations in MS. Multiple Sclerosis, Oct; 6 Suppl 2:S18-20; discussion S33.

National MS Society. (2016). The MS Disease-Modifying Medications.

National MS Society. Pregnancy and Reproductive Issues.

Pastò, L., et al. (2012). Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study. BMC Neurology, Dec 31;12:165.

Tsui, A., & Lee, M.A. (2011). Multiple sclerosis and pregnancy. Current Opinion in Obstetrics and Gynecology, Dec;23(6):435-9.

Vukusic, S., & Confavreux, C. (2006). Pregnancy and multiple sclerosis: the children of PRIMS. Clinical Neurology and Neurosurgery, Mar;108(3):266-70.

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