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 is actually protective for women with MS. Also, 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?
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 is like to care for babies and children of different ages.
- Discuss things with your partner and support system.
- Ask yourself some difficult questions, including: 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. Also, pregnancy seems to have a protective effect, possibly because pregnancy itself reduces immune activity and levels of natural steroids are higher in pregnant women. The number of MS relapses
are significantly decreased during pregnancy, especially in the second and third trimester. However, pregnancy does come with its own symptoms and discomforts, which may aggravate preexisting problems with your bladder, bowels or back or lead to greater fatigue.
4. What About Treatment During Pregnancy?
If you are on MS treatment
, you will probably be advised to stop while trying to conceive and throughout pregnancy.
- Tysabri and the interferons (Avonex, Betaseron and Rebif) are all Category C drugs, meaning it caused some harm to fetuses in animal studies, but the effect in humans is unknown.
- Glatiramer acetate (Copaxone) is a Category B drug, meaning it did not cause harm to fetuses in animal studies, but no adequate human studies have been done.
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 three months before trying to conceive, so the medication has time to clear. Some doctors may advise waiting a longer or shorter amount of time. Once this period is over, you should try to become pregnant as quickly as possible because you will be off medication during this time. Talk to your OB/GYN as soon as you can about what you can do to increase your chances of conceiving quickly, including monitoring ovulation and timing intercourse. She may want to run some tests to check your hormone levels. If a problem is suspected, many fertility-increasing options are available.
6. What is the Role of My 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 to do nothing.
7. Can I Use 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, so that there is a plan in place that everyone (including you) are comfortable with when the time comes. General anesthesia is also fine for women with MS.
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 between 20 to 40%. It is 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. It is wise to always have a plan in place for a relapse, no matter when it might happen, so that you can concentrate on getting better without the extra stress of scrambling for help.
9. Can I Breastfeed My Baby?
MS itself does not pose any obstacles to breastfeeding. However, since it is 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 like some genetic diseases, like cystic fibrosis. The evidence shows that there is about a 2% 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.
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