Even in the 21st century, some women with MS still report that they are met with either negative views or inaccurate information when asking questions about both pregnancy and childbirth. This short article aims to dispel some of the myths and misconceptions surrounding this area and provide up-to-date, accurate, evidenced-based information for women with MS who are currently pregnant or who are considering starting a family.
The effect of pregnancy and childbirth on women with MS
Prior to 1949, women with MS were advised to avoid pregnancy as they would make unfit mothers, their MS would progress disabling them further and they could pass the disease on to their baby. Further studies have long since dispelled these myths and the advice given to women is now very different. Research has proven that the long-term course of MS is, in fact, unaffected by pregnancy and most mothers with MS are perfectly able to care for their babies if they are given support.
Studies of pregnancy in women with MS have discovered that relapse rates are affected both during pregnancy and in the early postnatal period. The risk of relapse during early pregnancy probably will not alter, but there is a lower risk during the later months of pregnancy. The first three months after delivery pose an increased risk of having a relapse but then relapse rates will return to those of pre-pregnancy.
Most women feel well during pregnancy and the majority will not experience any new problems. There is a possibility however, that for some women some symptoms already experienced, such as fatigue or bladder and bowel problems, will worsen. The diagnosis of MS should be discussed with the medical professionals dealing with pregnancy and delivery at the start, and this person should have access to the MS professional. Any changes or increases in symptoms need to be discussed with your doctor, midwife or MS nurse.
Can MS be passed onto an unborn child?
MS is not an inherited condition, although there is a slightly higher chance of a child born to one parent with MS developing the disease compared to the average population. This chance is considered to be low, and is estimated at between one and four per cent; this should not discourage a couple from having children (see box below). Genetic counselling is not available yet as there is no identifiable gene strongly associated in the development of MS
How to manage drug regimens when planning to become pregnant
It is important to discuss medications before becoming pregnant, as some that are used in MS may be harmful to the baby. Generally, steroids are best avoided during pregnancy but under certain circumstances, for example if a severe relapse is experienced, the neurologist may decide the potential benefits outweigh the small risks.
Women taking disease modifying drugs (DMDs) such as beta interferon or Copaxone, are advised to discontinue them three months before stopping contraception. Although some women have continued to take them during pregnancy and have had perfectly normal pregnancies and babies, this is not recommended in general practice. Interferons are known to contain properties that can increase the risk of spontaneous miscarriage. They can be recommenced safely once the baby is born and the woman is no longer breast-feeding. If a woman on DMDs becomes pregnant unexpectedly, they are simply advised to stop taking them straight away; they will not require any special treatment or observation.
Breastfeeding
Breastfeeding has no negative effects on MS. Some small studies carried out recently even suggest breastfeeding could have a positive effect on the disease. This is still under investigation and has not been confirmed.
If a mother is experiencing problems with numbness or weakness in her arms or hands, positioning to feed the baby may be difficult. It is important to discuss such problems with the midwife or MS nurse, as they will be able to offer suggestions and advice on how to manage this.
Planning for a baby
When planning pregnancy it is important to consider:
• eating a healthy diet, taking regular gentle exercise and giving up smoking and alchohol before and during pregnancy
• taking folic acid before conception and three months into pregnancy
• speaking to the doctor regarding medication or any supplements that are taken
• that women with MS should not routinely require a caesarian section
• that women are able to receive an epidural or use a TENS machine (transcutaneous electrical nerve stimulation – a method of treating persistent pain that applies electrodes to the skin) if this is recommended
• planning with your partner who is going to do what in terms of household tasks, baby tasks etc
• that you do not have to cope alone. It can be helpful to highlight potential sources of help (such as family members and friends) who will provide support if it is needed
• a relapse may occur during the first few months after delivery and this needs to be discussed and planned for
• talking does help relieve stress. Talk over any anxieties with your partner, a friend or your midwife. Attend a local support group for mothers
• that fatigue levels may increase during and after pregnancy, and this can interfere with parenting activities. Ask your therapists or nurse about energy conservation techniques
• searching for aids and equipment that will make life easier
Conclusion
Pregnancy for any woman can be stressful, but there are even more worries and anxieties for the woman who also has to live with MS. Education with accurate and up-to-date information is essential to help reduce some of these anxieties and dispel many myths associated with pregnancy and childbirth. MS is well known for being unpredictable, and consequently a woman with MS has more reason than most to plan well in advance for both her pregnancy and for the potential practical support that may be required once the baby is born.
Will my baby have MS?
“Simple risk estimates are oversimplifications which can easily be misinterpreted. The reality is that risk estimates may be very different depending upon family structure. We now know that risks are much higher for families in which MS occurs in multiple relatives than for families in which there is only one affected individual. Risk is also moderated by ethnicity and by other factors we haven’t yet pinned down.” Dr. Stephen Hauser, MS Centre, Department of Neurology, University of California, San Francisco USA |
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