Multiple Sclerosis and Pregnancy

Multiple sclerosis (MS) is often diagnosed in women of childbearing age, and this fact prompts concerns regarding how MS can affect pregnancy. Fortunately, several studies have demonstrated that women with MS experience similar issues (if any) with pregnancy, labor, delivery, and fetal complications as women without MS.

In the past, pregnancy was believed to worsen MS, but after over 40 years of research it has been concluded that pregnancy reduces relapse rates, especially in the last trimester. Some studies show a decrease in MS symptoms during pregnancy but an increase in symptoms following delivery. This may be due to an increase in circulating proteins as well as natural immunosuppressants during pregnancy.

Research

The Pregnancy and Multiple Sclerosis (PRIMS) trial studied 269 pregnancies in women with MS. Results showed that while relapse rates were down by 70% in the third trimester, they increased 3 to 6 months post childbirth without contributing to increased disability in the long term.

Pregnancy and MS medications

Drugs such as DMTs and natalizumab (Tysabri) used to treat aggressive forms of MS should be discontinued a few months before conception. Research suggests there is no rebound of MS activity following drug withdrawal during or after pregnancy.

A recent study suggested that the use of fingolimod affected the fetus and should be avoided during pregnancy. Short-term steroid courses, however, are generally considered safe in pregnancy.

Intravenous immunoglobulin treatment has been found to be beneficial towards the end of pregnancy as this approach reduces relapse rates without significant side effects.

MS and childbirth

Physical disability related to MS may make it hard for the mother to carry the fetus during pregnancy, and this is further affected by coordination problems, fatigue, and muscle weakness.

Women with MS may not have pelvic sensation during labor, which will affect their ability to feel the labor pain, thus complicating delivery. Labor may also be complicated due to affected muscles and nerves which hinder pushing.

Breastfeeding and MS

Breastfeeding for a minimum of 2 months has been linked to a reduction in MS relapses. Breastfeeding women have a 50% less chance of a postpartum relapse as compared to non-breastfeeding women.

MS and IVFApart from the other benefits for the infant such as protection from asthma, type 1 diabetes, Crohn’s disease, and dermatitis, breastfeeding may also provide the baby protection against MS. According to a German study, breastfeeding for just 4 months after childbirth reduces the baby’s risk of developing MS at a later stage by 50%.

The hormonal changes caused by in vitro fertilization (IVF) are believed to affect MS. According to studies, gonadotropin releasing hormone (GnRH) agonists may be linked to an increase in relapse rates for about 3 months post treatment.

IVF failure has also been shown to increase relapse rates, perhaps due to the mirroring of hormonal status postpartum. Low-dose naltrexone has been found to be effective in treating infertility in women with polycystic ovarian syndrome, and this medication also has benefits in MS.

Inheritance

MS is not inherited directly, unlike Huntington’s disease or cystic fibrosis, so the chances of the fetus getting MS from the mother are very low. There is only a 2% risk of children developing MS if they are born to a parent with the disease.

Support initiatives for MS during pregnancy

Women with MS need more support and rehabilitation during pregnancy. The extent of rehabilitation will depend on the severity of symptoms. Care should be taken to help restore essential day-to-day functions, promote independence, encourage family involvement, and educate women about assistive devices such as canes and walkers.

Support programs should aim to establish a proper exercise regimen that promotes muscle strength and control as well as a treatment protocol that effectively manages bowel or bladder incontinence.

Cognitive retraining and enhancing safety, mobility, and accessibility are also two primary concerns for pregnant MS patients. Additionally, MS needs to be closely monitored in pregnant women through more prenatal hospital visits.

Stress management is another important supportive component for pregnant women with MS as stress is closely linked to relapses. Studies have shown that stress-reduction programs reduce fatigue, depression, and the development of fresh lesions in women with MS.

References

• http://www.nationalmssociety.org/Living-Well-With-MS/Family-and-Relationships/Pregnancy
• http://www.hopkinsmedicine.org/healthlibrary/conditions/physical_medicine_and_rehabilitation/multiple_sclerosis_and_pregnancy_85,P01160/
• https://overcomingms.org/ms-a-to-z/ms-encyclopedia/pregnancy-and-ms/
• https://www.mssociety.org.uk/what-is-ms/womens-health/pregnancy-and-birth