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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Multiple Sclerosis and Pregnancy


March 20, 2013

Pregnancy Guide
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Pregnancy and Illness
Multiple Sclerosis and Pregnancy
Multiple Sclerosis and Pregnancy
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Pregnancy and childbirth don't have any negative long-term effects on women with multiple sclerosis.
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InteliHealth
2009-07-01
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InteliHealth Medical Content
2011-08-04

Multiple Sclerosis and Pregnancy

Multiple sclerosis (MS) is a disabling neurological illness. It affects the brain and spinal cord. The disease is usually progressive. Women are twice as likely to develop MS as men. And most are women in their 20’s and 30’s.

If you have MS, you're probably wondering how a pregnancy might affect your health and that of your child. Although there are many unknowns about MS, including the exact cause, researchers do have some important answers for you.

Pregnancy and childbirth don't have any negative long-term effects on women with MS. But because MS symptoms can range from mild blurring of vision to total paralysis, you'll want to consider what your degree of disability would mean to your ability to care for a baby. You should also keep in mind that the course of the disease is highly unpredictable. You'll need special care and support both during pregnancy and in the weeks after delivery.

Also you need to think about your medications. In general, the disease modifying drugs are not FDA approved for pregnant women. Ideally, discuss what pregnancy might mean for you before getting pregnant.

It's uncommon for expectant mothers who have MS to experience worsening of central nervous system symptoms. In fact, for most women with MS, pregnancy actually seems to give some protection against disease flare-ups. But it can make them more susceptible to other health problems, including fatigue (especially during the first three months), constipation and urinary tract infections (already more frequent among women with MS).

As you near term, you may also find that you are less steady on your feet, making it a good idea to install grab bars, particularly in the bathroom. An obstetrician may suggest such precautions as using a stool softener to counter constipation, regular urine cultures to detect possible infections, a change of MS medication or other measures appropriate to your case. Labor for a woman with MS is usually handled in much the same way as for other women. Women with a pronounced lack of sensation or paralysis may also be monitored closely during the ninth month in case they are unable to detect the onset of contractions or need to have labor induced after the cervix starts to open.

In the postpartum stage, there is a 20-40% higher risk of an MS flare (called an exacerbation).  If you do get a worsening of symptoms, however, it's unlikely to be permanent. Studies of women with MS who had children did not have a higher rate of disability compared to women that were never pregnant.

The first 6 months after you've given birth are the highest risk period for disease flare-ups, so you'll want to take as good care of yourself as possible. Getting enough rest and trying to avoid infections, fevers, stress and anemia can help to prevent this problem.

On the question of breastfeeding, the answer varies according to your specific case. For some women with MS, breastfeeding is too tiring, or for others who use certain medicines, it may not be medically recommended. Most mothers with this disease can nurse a baby. Be sure to discuss the topic with your obstetrician, pediatrician and neurologist before you make a final decision. Current medical information shows no elevated risk of exacerbations caused by breastfeeding.

Finally, the risk that your baby will someday develop MS is only 1% to 5%.  Although MS is not a directly inherited disorder, genetic factors are thought to play a role in some individuals. Whether the mother or father has MS does not matter – both confer a similar risk to the child. Because women have a higher risk than men, a daughter will have a greater risk of developing MS compared to a son.

To learn more about MS or MS and pregnancy, or to locate a chapter near you, call the National Multiple Sclerosis Society at 1-800-344-4867, or visit their Web site at www.nmss.org.

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