Multiple Sclerosis and pregnancy

While there are unique challenges, many women with MS successfully navigate pregnancy and childbirth into experiencing the joys of motherhood. How can you This article can you manage this condition and ensure a healthy pregnancy.

What is Multiple Sclerosis (MS)?

MS is characterised by the immune system attacking the protective sheath (myelin) that covers nerve fibres, leading to disconnected communication pathways between the brain and the rest of the body. Symptoms vary widely but can include fatigue, difficulty walking, numbness or tingling, muscle weakness, and problems with coordination and balance. The course of the disease is unpredictable, with periods of remission and relapse.

MS and fertility

One of the first concerns for women with MS contemplating pregnancy is fertility. Research indicates that MS does not directly impact fertility rates. Women with MS have the same likelihood of conceiving as those without the condition. However, some symptoms of MS, such as fatigue and depression, may indirectly affect sexual activity and libido, potentially influencing conception efforts.

Check out: Myths about miscarriages

Consultation with healthcare providers

Non Helena Smit, the director at Multiple Sclerosis South Africa (MSSA) advises, “Before attempting to conceive, individuals with MS should discuss their plans with their healthcare team, including neurologists and obstetricians. They can provide guidance on managing MS symptoms during pregnancy and adjusting medications if necessary.” This collaborative approach ensures that women receive personalized advice and care tailored to their specific needs and circumstances

What to expect during pregnancy

Disease activity

“Women with MS may experience changes in disease activity during pregnancy,” said Smit. “Some women have fewer relapses, particularly during the second and third trimesters, due to the natural immunosuppressive state of pregnancy, which reduces the likelihood of autoimmune attacks. However, the postpartum period often sees an increased risk of relapse, necessitating careful monitoring and management.”

Medication management

Managing MS symptoms during pregnancy requires a collaborative approach between neurologists, obstetricians, and other healthcare providers. Smit emphasizes, “Certain MS medications may need to be adjusted or discontinued during pregnancy, as they may pose risks to the developing foetus.

Healthcare providers can help determine the safest course of action and monitor the individual’s condition closely throughout pregnancy.” This can be challenging, as some women may experience a resurgence of symptoms without their regular medication regimen. Non-pharmacological approaches, such as physical therapy, acupuncture, and dietary modifications, may also be beneficial in managing symptoms.

Pregnancy planning

Smit says, “Planning pregnancy during periods of remission may reduce the risk of relapses during pregnancy. It is essential to ensure that MS is well-managed before conception.” By stabilising the condition prior to pregnancy, women can reduce the likelihood of disease activity during this crucial time. A well-thought-out plan, in consultation with healthcare providers, can make a significant difference in pregnancy outcomes.

Prenatal care and monitoring

Regular prenatal check-ups are important for women with MS. Smit advises, “Regular prenatal check-ups and monitoring are crucial for both the mother’s and baby’s health. Healthcare providers will monitor MS symptoms, assess medication safety, and address any complications that may arise during pregnancy.” These appointments allow healthcare providers to monitor the health of both the mother and the baby closely. Given the increased risk of complications, such as urinary tract infections (UTIs) and blood clots, frequent monitoring ensures that any issues are promptly addressed.

Also visit: What is secondary fertility?

Specialised care

Women with MS may benefit from specialised care during pregnancy. High-risk obstetricians, who are experienced in managing pregnancies complicated by chronic illnesses, can provide tailored care plans. Additionally, consultations with neurologists are essential to adjust treatment plans as needed.

Birth delivery method

The choice of delivery method—vaginal birth versus caesarean section (C-section)—is often a concern for pregnant women with MS. Most women with MS can safely have a vaginal delivery. However, if MS symptoms such as muscle weakness or fatigue significantly impact labour, a C-section may be recommended. The decision should be made in collaboration with healthcare providers, considering the mother’s overall health and MS status.

Pain management

Pain management during labour is another important consideration. Epidural anaesthesia is safe for women with MS and can provide effective pain relief. However, it is essential to discuss anaesthesia options with healthcare providers well in advance of delivery to develop an appropriate plan.

Postpartum considerations

Risk of relapse

The postpartum period is associated with an increased risk of MS relapse, particularly within the first three to six months after childbirth. Non Helena Smit advises, “MS symptoms may fluctuate in the postpartum period, and healthcare providers can provide guidance on managing symptoms while caring for a newborn. It is essential to have a plan in place to manage potential relapses. This may include resuming disease-modifying therapies that were paused during pregnancy. Breastfeeding can pose additional considerations, as some MS medications may not be safe for nursing infants.”

Breastfeeding

Many women with MS can breastfeed successfully. Breastfeeding has numerous benefits for both the mother and the baby, including bonding and providing essential nutrients. However, some disease-modifying therapies may need to be avoided or adjusted during breastfeeding. Women with MS should discuss their breastfeeding plans with their healthcare providers to ensure the safety and well-being of both mother and child.

Emotional and psychological support

Pregnancy and motherhood can be emotionally challenging, and this is particularly true for women with MS. The physical and psychological demands of managing a chronic illness alongside pregnancy can be overwhelming. Access to emotional and psychological support is crucial. Support groups, counselling, and therapy can provide valuable resources for coping with the unique challenges faced by pregnant women with MS.

Family planning

For women with MS considering future pregnancies, family planning is an important aspect of care. Discussing family planning goals with healthcare providers can help in developing a comprehensive plan that considers the timing of pregnancies, potential risks, and strategies for managing MS during future pregnancies.

Smit concludes: “Overall, with proper medical management and support, many women with MS can have successful pregnancies and healthy babies. Open communication with healthcare providers and careful planning are key to ensuring the best possible outcomes for both mother and child.”

Collaboration with healthcare providers, pro-active symptom management, and access to emotional and psychological support are key components in navigating this journey. As research continues to advance, the outlook for women with MS who wish to become mothers remain positive, offering hope and possibilities for the future.

Also read: Managing MS