Experiencing Multiple Sclerosis During Pregnancy
Many people living with MS face everyday challenges such as muscle spasms, numbness, extreme fatigue, mood changes, and more. Women who live with MS and who want to start a family might be wondering if pregnancy would be healthy for them.
Of course, while this is a natural response, the chances of pregnancy and deliverance are the same as women without MS.
There are a few obstacles that mothers to be with MS face; however, by planning ahead with proper medical management and family support, you can endure the next 9 months a little bit easier.
Before pregnancy
Speak with your doctor about managing MS and being pregnant. Have your doctor address your questions and concerns, as well as guide you to appropriate resources.
Speak with your doctor about stopping your intake of certain medications. Some MS drugs, such as glatiramer acetate (Copaxone) and interferons are not safe during pregnancy and should be discontinued at least 1 month before you start trying to conceive. “But going off medication increases the risk for relapse. So you have to determine which therapy is safest for the mother and baby” said Dr. Bianca Weinstock-Guttman, professor of neurology at the University Of Buffalo Jacobs School Of Medicine.
Learn about your “fertility window”. Be sure to time your pregnancy just right. You may even consider buying an ovulation kit to help you figure it out.
Have a supportive medical team. Together with a supportive medical team, you can discuss your specific questions and concerns regarding MS and pregnancy.
During pregnancy
Expect some relief of MS flare-ups. Research shows that MS flare-ups tend to decrease after the sixth month of pregnancy. “In order for the mother to host and nourish the fetus, and help it develop, a number of immune changes have to happen. We think some of those immune changes may also lead to a decrease in relapses” said Dr. Riley Bove, assistant professor at the University Of California San Francisco School Of Medicine.
Stay hydrated. Urinary tract infections are more common in pregnant women with MS so remember to drink plenty of liquids. Moreover, if you are experiencing symptoms such as a burning sensation while urinating, contact your doctor right away.
Exercise on a regular basis. “Exercise reduces MS fatigue, keeps your muscles and joints healthy, and produces endorphins (the body’s feel-good chemicals)” said Dr. Weinstock-Guttman.
Use adaptive equipment. MS causes muscle stiffness and difficulty walking so as you move ahead in your pregnancy, you may need a cane or another type of walking aid to help you maintain your balance and to prevent you from falling.
Build a support team. Have a support team of family and friends who will help you with everyday tasks such as cooking and cleaning during pregnancy. This way, you can save up your energy and focus on your baby.
Ask your doctor for an epidural. During delivery, if you want and need an epidural, you should consult with your doctor. Such injections are safe even for women with MS.
After childbirth
Anticipate flare-ups. Over 40% of women with MS experience relapse during the first 3-6 months after having given birth. This is thought to occur due to hormonal changes within the body. For this reason, speak with your doctor about continuing with your MS medication.
Anticipate fatigue in the short team after having given birth. Focus on mothering, getting enough rest, and maintaining your well-being.
Be aware of MS medications and breastfeeding. If you decide to go back on your MS medications, you will not be able to breastfeed. The medications can cause harm to your baby through your milk. Talk with your doctor and see if you can wait to take your MS medication or perhaps he or she can offer another helpful recommendation for you and your baby.
Be aware of any changes in your mood. After having given birth, women with MS are at a higher risk of depression. If you begin to notice any changes in your mood, such as feeling sad, hopeless or guilty, speak with your doctor right away so that he or she can help treat your depression symptoms.
Perform relaxation techniques. Try performing a few relaxation techniques such as yoga or meditation to lower your stress levels. “Psychological stress may increase the risk for postpartum depression” said Dr.Weinstock-Guttman.
Have family members or friends help with your specific tasks. During the first few months after having given birth, have your family and friends help you. They can make your days just a little bit easier while caring for your newborn. You may even consider hiring help, such as a babysitter.
Research to assess the course of MS during pregnancy
Pregnancy in MS has always been a debatable topic and most recently, a study was conducted in order to assess the clinical course of MS during pregnancy, as well as treatment options, obstetrical outcomes, and breastfeeding results. The study involved the participation of 97 women with relapsing-remitting MS at least one year prior to pregnancy and 127 pregnancies (111 deliveries, 11 spontaneous abortions, 3 fetal deaths, and 2 voluntary abortions). Furthermore, the study was divided and evaluated based on 3 periods: one year prior to pregnancy, during pregnancy, and one year after childbirth.
The results from the study showed:
- Relapse rates decreased mostly in the third trimester of pregnancy
- No significant changes in relapse rates were seen during the year after childbirth
- Women with relapses during the year after childbirth had a shorter disease duration at conception and breastfed less
- No previous disease modifying therapy given to over 80% of the women, breastfeeding, delivery, or epidural analgesia had an impact on the presence of relapses during the year after childbirth
- Caesarean delivery was performed in over 40% of the women due to fetal-pelvic incompatibility and epidural analgesia was performed in more than 60% of the women
- The most frequent complications seen were restriction of fetal growth (4.5%) and gestational diabetes mellitus (3.5%)
- 6.4% of newborns experienced birth asphyxia and 6.1% had a low birth weight
- No malformations were recorded
The results from the study concluded that despite a decrease in relapse rates during pregnancy, the presence of relapses was seen during the year after childbirth. Disease modifying therapy had no impact on clinical or obstetrical outcomes and MS did impact the course of pregnancy in any harmful way. Furthermore, caesarean delivery and epidural analgesia were performed safely in all MS patients and breastfeeding results showed no influence on MS activity.
Having MS does not have to stop you from getting pregnant and if your main concern is whether your baby will grow up to have MS, you should know that contrary to some conditions, MS is not directly inherited from parent to child. Although the disease does include a few genetic links, children with a parent who has MS have only a 1.5% risk of getting the disease - this means that 1 in 67 children born to a parent with MS is likely to develop MS themselves. Yet, a recent study suggests that this figure may perhaps be even smaller.
References
https://www.webmd.com/multiple-sclerosis/guide/healthy-pregnancy#1
https://www.healthline.com/health/multiple-sclerosis/pregnancy-safe
https://www.ncbi.nlm.nih.gov/pubmed/29055477
https://www.mssociety.org.uk/what-is-ms/womens-health/pregnancy-and-birth
