• Women with MS can usually have safe, healthy pregnancies with the help of their neurologist and OB-GYN.
• Labor management and delivery for women with MS is similar to that of women without MS — although some women may require a cesarean section due to MS related symptoms.
• Relapses may lessen during pregnancy and increase postpartum.

Women of childbearing age with MS can usually have safe, healthy pregnancies. Knowing what to expect can help you feel prepared. MS can impact pregnancy, delivery, and the postpartum period.

Managing MS While Pregnant

During pregnancy, it is important to talk to your doctor and take preventative measures to maintain your health and immune system. Closely monitor the impact pregnancy is having on your MS. Common MS symptoms, such as fatigue, can worsen during or after pregnancy. Get plenty of rest, simplify day-to-day activities, and avoid stress whenever possible.

Women who have trouble walking may encounter more difficulties during late pregnancy as they become heavier and their center of gravity shifts. Discuss with your doctor whether assistive devices like walkers or wheelchairs could be helpful during this time.

Women with MS may have lower levels of vitamin D during pregnancy and postpartum. It is recommended that women talk to their doctor about being evaluated and treated for vitamin D deficiency prior to pregnancy. In addition, like all women seeking to become pregnant, those with MS should follow their doctor's advice about taking prenatal vitamins and folic acid.

Medical Procedures

Currently, there is no evidence that receiving an MRI scan is harmful to the fetus during pregnancy, but MRI using gadolinium should be avoided during pregnancy due to a possible risk of rheumatological, inflammatory, or infiltrative skin conditions and of stillbirth or neonatal death.

Use of assisted reproductive technologies, such as in vitro fertilization, is associated with an increased risk of MS relapse.

MS Relapse During Pregnancy

If you have an acute MS relapse during pregnancy, it is important to contact your doctor. Based on available data, relapses during pregnancy can be treated, and recommended treatments vary by trimester.

Studies have shown that intravenous immunoglobulin (IVIG) is safe throughout pregnancy and is therefore preferred for the first trimester. Steroids have been used safely in the second and third trimesters.

Other medications used to manage MS, such as disease-modifying therapies, may not be appropriate — depending on whether a woman is pregnant or not. Some MS therapies can cause birth defects, while others do not. Research has shown that use of a disease-modifying therapy is associated with a lower risk of postpartum relapse. As always, follow your doctor's advice regarding treating relapses.

How Does MS Impact Delivery?

MS can lead to increased risk for certain birth complications, so it is important to plan ahead. Some studies have reported lower birth weights in babies born to women with MS compared with the general population. However, other studies have not reported this finding.

Women with MS are not adversely affected by general anesthesia and epidurals. Women with MS may require a cesarean section (C-section) due to MS-related symptoms, such as fatigue, muscle stiffness, slower progression of labor, or pelvic-organ dysfunction.

Talk to your OB-GYN about your MS diagnosis and what you can do to plan ahead for your delivery.

Postpartum Self-Care

It is important to prioritize yourself and your health while taking care of a new baby. Set realistic expectations for yourself and lean on family and friends when you need to.

Fatigue is common among new parents. It is important to set realistic expectations for yourself, as common daily activities can now become unmanageable. Don’t feel guilty or disappointed if you have trouble managing your daily activities. Give yourself permission to lean on others for help.

Parents with MS should plan for help with child care, especially if they have older kids in the house. Work with family members, friends, neighbors, or other parents in your community and establish a list of people you can call when you need alternate child care.

Treating MS Postpartum

Research has shown that pregnancy does not impact long-term disability in MS.

For most women with MS, the relapse rate is lower during pregnancy, particularly in the third trimester. This can be followed by a higher risk of relapse in the postpartum period. (For women who have had miscarriages, the risk of MS relapse is also increased for the first year after, in comparison to the year before that pregnancy.)

It is important to plan ahead and discuss with your doctor when to restart treatment. Work with your spouse and loved ones to set up a support schedule to ensure you will have the helping hands you need. It is important to take care of your family without jeopardizing your own health.

Breastfeeding With MS

In women with MS, breastfeeding does not seem to have an adverse effect on the rate of relapses or the progression of disability. Ask your neurologist about using disease-modifying therapies to treat your MS while you are breastfeeding.

Postpartum Depression and MS

Postpartum depression is feeling sad, hopeless, or empty for more than two weeks after giving birth. It may include other symptoms of depression, like mood swings, reduced concentration, or trouble sleeping. If you find yourself with strong feelings of sadness that make it hard for you to take care of yourself or your baby, talk to your doctor. Postpartum depression is a medical condition that requires treatment to get better.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 169,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you planning a family while living with MS? Share your experiences in the comments below or start a conversation by posting on your Activities page.

References

1. 1. Practical Evidence-Based Recommendations for Patients With Multiple Sclerosis Who Want To Have Children — Neurology and Therapy
   2. Pregnancy and Multiple Sclerosis — Journal of Midwifery & Women’s Health
   3. Pregnancy and Reproductive Issues — National Multiple Sclerosis Society
   4. Management of Women With Multiple Sclerosis Through Pregnancy and After Childbirth — Therapeutic Advances in Neurological Disorders
   5. Management of Multiple Sclerosis During Pregnancy and the Reproductive Years: A Systematic Review — Obstetrics & Gynecology
   6. Artificial Reproductive Techniques in Multiple Sclerosis — Clinical Immunology
   7. Pregnancy: Effect on Multiple Sclerosis, Treatment Considerations, and Breastfeeding — Neurotherapeutics
   8. Multiple Sclerosis Management and Reproductive Changes — Neurology: Clinical Practice
   9. Abortion Induces Reactivation of Inflammation in Relapsing-Remitting Multiple Sclerosis — Journal of Neurology, Neurosurgery, and Psychiatry
   10. Pregnancy and Multiple Sclerosis: The Influence on Long-Term Disability — Clinical Neurology and Neurosurgery
   11. Rate of Pregnancy-Related Relapse in Multiple Sclerosis — The New England Journal of Medicine
   12. Postpartum Depression — Office on Women’s Health, U.S. Department of Health & Human Services
   13. Predictors and Dynamics of Postpartum Relapses in Women with Multiple Sclerosis — Multiple Sclerosis