Pregnancy and Multiple Sclerosis

9 Frequently Asked Questions If Planning a Family

For many women living with multiple sclerosis (MS), the diagnosis comes at the time when they are thinking about starting a family. In the past, women with MS were actively discouraged from doing so as it was presumed they would get ill and be less able less able to care for young children. Luckily for us all, the picture is much brighter today.

In fact, studies have shown that pregnancy reduces a woman's risk of experiencing a relapse, especially during the third trimester. Moreover, the current disease-modifying therapies give women a far better chance of staying healthy throughout not only their pregnancy but the many school years to follow.

1
Am I More Likely to Have Pregnancy Complications?

Pregnant Woman Getting Ultrasound
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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 either 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.

2
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 by increasing levels of natural steroids.

With that being said, pregnancy does come with its own symptoms and discomforts which may aggravate pre-existing MS conditions like bladder problems or fatigue.

3
Can I Take My MS Medication During Pregnancy?

If you are on MS treatment, you will probably be advised to stop therapy while trying to conceive and throughout the course of your pregnancy. Among the treatment considerations during pregnancy:

  • Copaxone (glatiramer acetate) is a pregnancy category B drug meaning that it did not cause harm in animal studies but that no adequate human studies have yet been done.
  • The interferons (Avonex, Betaseron, Rebif, Plegridy, and Extavia) are all pregnancy category C drugs meaning that they did cause harm to animal studies but that the effect in humans is still unknown.
  • Tysabri (natalizumab) and Lemtrada (alemtuzumab) are MS treatments delivered intravenously that are both category C drugs.
  • Gilyena (fingolimod) and Tecfidera (dimethyl fumarate) are oral MS medications that are pregnancy category C.
  • Zinbryta (daclizumab) in MS drug delivered by subcutaneous injection classified as category C.
  • Novantrone (mitoxantrone) is also an intravenous medication belonging to pregnancy category D. This means that studies have demonstrated fetal harm but that the benefits of treatment may outweigh the risks in certain individuals. 
  • Aubagio (teriflunomide) is an oral pregnancy category X drug. This means it is contraindicated during pregnancy or when attempting pregnancy.
  • Ocrevus (ocrelizumab) has not been assigned a pregnancy category as it is still relatively new.

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

4
What If It Takes a Long Time to Get Pregnant?

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

It is usually a good idea to meet with your OB/GYN specialist and discuss what you can do to increase your chances of conceiving quickly, including tracking ovulation

5
What Is the Role of My Neurologist?

Your neurologist will have an opinion about therapy options, both when you are trying to conceive and during pregnancy. There may also be precautions to take to prevent relapse after you deliver.

Studies have shown that a dose of intravenous immunoglobulin (IVIG) given to women immediately after childbirth significantly reduces the risk of postpartum relapse. Some neurologists may prescribe one or several doses of Solu-Medrol (intravenous corticosteroids) for the same purpose, while others prefer a more watch-and-wait approach. 

6
Can I Use Have an Epidural During Delivery?

In the past, some neurologists advised against using spinal anesthesia (also known as a spinal block) as they believed there was a greater risk of complications. However, recent research has shown that women who had an epidural (another form of local anesthesia) did not have a higher number of relapses than those who did not.

Today, according to the National Multiple Sclerosis Society, all types of anesthesia are considered safe for women with MS during labor and delivery.

Even so, the choice of anesthesia should be discussed with your neurologist, obstetrician, and anesthesiologist early in the third trimester. In this way, there is a plan in place that everyone will be comfortable with when the time of delivery finally arrives.

7
There a Risk of Relapse After My Baby is Born?

Your risk of a relapse in the first six months following delivery is between 20 percent and 40 percent.

Because of this, it is important that you have a plan in place in case you do experienc a relapse (including having someone to take you to the doctor and helping with the baby). As with all things in MS, no one can predict if you will have a relapse and, if you do, what symptoms you may have.

8
Can I Breastfeed?

MS itself does not pose any obstacle to breastfeeding. However, since it is not known whether disease-modifying drugs can be passed in breast milk, most doctors will advise against resuming therapy until after you have finished breastfeeding.

Some women with MS will choose to resume therapy immediately and formula-feed their babies (thereby reducing the risk of a relapse). Others, meanwhile, will breastfeed for a period of up to four months to give their infants the benefits of breast milk.

Neither are right or wrong decisions. In the end, only you can decide what is best for you and your baby.

9
Will My Baby Have MS?

While  MS is not directly inherited, certain genes do play a role. Research suggests there is between a two and five percent chance of a child born to a parent with MS developing MS as well.

However, it is important to note that there is currently no genetic or prenatal test—or even tests for your newborn—that can predict the likelihood of this happening.

A Word From Verywell

Whether you are talking to your partner about conceiving or are already pregnant, continue to educate yourself and follow up closely with your neurologist.

While it may sometimes be challenging to deal with the combined stress of MS and pregnancy, remain resilient and continue to take an active role in your health. The payoff will almost certainly be worth it.

Sources:

Brandt-Wouters, E.; Gerlach, O.; and Hupperts, R. "The effect of postpartum intravenous immunoglobulins on the relapse rate among patients with multiple sclerosis." Int J Gynaecol Obstet. 2016; 134(2):194-6.

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

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

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