Pregnancy, Childbirth, Breastfeeding, and Multiple Sclerosis (MS)

Many women with multiple sclerosis have children after diagnosis. Therefore, there will be extra things to plan for. However, women with MS can have a healthy pregnancy, a safe birth, and a successful breastfeeding experience.

Key takeaways:
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    Many women with MS have children, though there are extra considerations.
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    MS symptoms often decrease during pregnancy and increase right after birth.
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    Some MS medications cannot be taken while pregnant or breastfeeding.

For many years, women with multiple sclerosis (MS) were discouraged from getting pregnant because there were too many unknowns. Questions like, "How does the disease affect the fetus?" and "Is there an added risk to the mother?" weighed on parents' minds. Many people with multiple sclerosis have children; however, they have a few extra things to consider when deciding to have a baby. Questions that arise may include whether MS can be transmitted to the baby, what impact pregnancy has on MS, what impact medications have on pregnancy, and if breastfeeding is safe. Every person is different, but there are some general guidelines.

Pregnancy with MS

Pregnancy changes the way the immune system works. In general, there is a decrease in inflammatory chemicals. This may lead to lower levels of inflammation, which may ease MS symptoms.

Studies show that pregnancy won’t worsen MS. Research shows that for some women, MS symptoms even improve during pregnancy, particularly during the third trimester. This is thought to be caused by increases in progesterone and estrogen hormones.

Relapses seem to happen less often during pregnancy as long as particular disease-modifying therapies (DMTs) are continued. Some DMTs can harm the fetus if taken during pregnancy. There is a balance of risk and benefit. Continuing DMTs depends on how active the disease is and should be discussed with a healthcare professional.

DMTs that are not safe to continue during pregnancy include:

  • Fingolimod (Gilenya).
  • Teriflunomide (Aubagio).

DMTs that may be continued, depending on what your doctor suggests, may include:

  • Beta interferons
  • Natalizumab (Tysabri).
  • Glatiramer acetate (Copaxone).

Steroids are sometimes taken during an MS relapse and are usually considered safe during pregnancy. Your doctor may suggest that you stop a DMT before trying to get pregnant. This may need to happen several months in advance to clear the medication out of your body. You should talk with your doctor before stopping or starting any medication.

Though MS isn't directly inherited, there is no prenatal test to determine the transmission risk to the baby. Furthermore, scientists don't know the exact cause of MS, but they have determined that genetics does play a role. Studies show that there is only a 2-3% chance that a child will be born with MS. It's best for parents to plan ahead if the mother has MS. Discuss your questions and concerns with your doctor before planning for a baby.

MS and childbirth

Fortunately, the scientific data does not show that MS increases the risk of miscarriage, stillbirth, premature birth, birth defects, or ectopic pregnancy. Additionally, many people with MS tolerate anesthesia well during childbirth, including epidurals.

Childbirth can be different for people with MS, depending on nerve damage. For example, nerve damage near the pelvis can make it difficult to engage the muscles needed to push out a baby. As a result, some studies show higher rates of non-emergency C-sections among people with MS. However, many women with MS experience normal childbirth.

The risk of an MS relapse increases during the first three months postpartum. This is thought to be caused by decreases in hormonal levels after childbirth.

The first few days and weeks after giving birth are exhausting for anyone, but especially for people with MS. Fatigue can be hard to manage, so getting help from family and friends is important. In addition, ask your doctor if they can put you in contact with extra support services to help ease the transition into parenthood — especially during the early stages.

It is common for new mothers to experience postpartum depression. However, having MS is an additional risk factor for depression. After giving birth, watch for signs of worsening depression and talk to your doctor if you need help.

Does MS affect breastfeeding?

It is usually safe for mothers with MS to breastfeed — and they can’t pass on their MS to their babies through breast milk. Several different hormones are higher in the body during the breastfeeding months. Some studies have shown that MS symptoms can increase during breastfeeding as a result.

The choice to breastfeed should be discussed with your doctor since some DMTs pass through the breast milk and may harm your baby. Steroids are usually considered safe to use while breastfeeding if needed for relapse. However, minute amounts of steroids do pass through the breast milk. It may be best to take the steroids several hours before breastfeeding to minimize the effect.

Some parents store extra breast milk in the freezer to use if symptoms keep them from breastfeeding. Breastfeeding is very beneficial to your baby, so your doctor may speak with you about whether the benefits outweigh the risks.

Studies show that people with MS can have safe pregnancies and healthy babies. Managing MS well before getting pregnant is the best way to increase the chance of having an uncomplicated pregnancy. Your doctor will help you manage symptoms along the way and may make changes to medications. Studies have shown that people with MS are just as likely to have successful pregnancies as people without MS.

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