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Women's Issues
Booklet containing tips and suggestions on how best to plan for birth; plus other issues relating to women.

MS and pregnancy

How will having MS affect pregnancy or giving birth?

Having MS will not directly affect pregnancy, labour or giving birth. Several studies have shown that mothers with MS are just as likely as any other mothers to have healthy pregnancies and babies, and there is no research to show MS may increase risk of ectopic pregnancy (where a fetus develops in the fallopian tube), miscarriage, premature birth, still-birth or birth abnormalities.

It is generally advised that, as with other women, natural birth is a good option. Having MS does not mean there is a need for a caesarian.
During birth itself, problems with weakness, spasms or stiffness in the legs can be managed with the assistance of the doctor or midwife. Many women opt for having an epidural for pain relief during birth. Both epidurals, and anaesthetics for caesarean births, are safe in women with MS.

Does pregnancy affect MS relapses?

There have been many research studies examining the impact of pregnancy on MS. They all show that pregnancy appears to have a positive protective influence, with relapse rates going down, especially during the third trimester (that is between six and nine months). The reasons for this are not fully understood, but it is thought that hormone levels play a role. Improvements during pregnancy may also relate to the fact that immune system activity is lowered in pregnant women to stop them from rejecting the baby. Similar effects are seen in women with other autoimmune conditions.

However, in the first three months after the baby is born, the risk of relapse rises. This is thought to occur as hormones return to pre-pregnancy levels. Research suggests that these post-pregnancy relapses do not increase long-term levels of disability. In other words, pregnancy has no effect on the progression of MS in the long-term, rather the overall effect is neutral.

Can pregnancy affect MS symptoms?

Although women may have fewer relapses during pregnancy, other MS symptoms can be affected. Many women report that their fatigue becomes worse during pregnancy, but this can be managed by careful time planning. The MS Society publication Fatigue and MS gives more information on managing fatigue, and on how to make maximum use of your available energy. Balance and back pain can also get worse during pregnancy, as the extra weight of carrying a baby can cause a shift in the centre of gravity. Walking aids may be useful at this time and help prevent stumbles and falls. Any pre-existing bladder and bowel problems may also feel worse or become aggravated during pregnancy. A continence nurse or advisor can give help and advice on how to manage these symptoms.

Can medications used to treat MS affect pregnancy?

Before you start trying for a family, you should talk to your doctor about your symptoms and any medications you are taking. As some medications are not advised during pregnancy, your doctor may wish to review your prescriptions. If you find you become pregnant unexpectedly and have not had your medications reviewed, it is important that you consult your doctor as soon as possible.

When determining whether you should stop taking a medication during pregnancy, the doctors will look at the risks that this would pose to you and the baby. However, the risks of many medications during pregnancy are unknown, as it is unethical to carry out clinical trials to assess the effects of drugs on developing fetuses. The evidence of harmful effects in humans comes from a small number of cases where a woman has become pregnant when taking a particular medication.
In the case of disease modifying drugs, two research studies have looked at the effects of beta interferon during pregnancy. One found there may be a slight increase in miscarriages when a woman has taken beta interferon during pregnancy, the other found there was no significant difference. As there is still limited information in this area, women are advised to stop taking disease modifying drugs, including beta interferon 1b (brand names Betaferon, Avonex and Rebif) or glatiramer acetate (brand name Copaxone), at least three months before trying to get pregnant. If you do become pregnant while taking disease modifying drugs, you should consult your doctor as soon as possible.
Steroids are considered to be relatively safe during pregnancy. They are, however, generally avoided during the first three months when fetal organs are developing and extra caution may be needed.
In case of medications for other health conditions or symptoms, the general rule is to err on the side of caution. However, if coming off medications would pose a serious risk to mother or baby, doctors may advise that they should be continued, or opt for alternative drugs.
Your doctor or other healthcare specialists may be able to advise you of ways to manage the symptoms that do not involve medication. All treatments can be resumed immediately after giving birth, although some may not be appropriate if you choose to breastfeed.
Whether or not you have MS, the period immediately after the birth can be very tiring and it can take time to adapt to the demands of having a baby to care for. For women with MS, planning to ensure there is support during this time is particularly important. You may wish to contact and make lists of family and friends who can help with specific tasks, and find out about health services, local service provisions for mums and support groups. Many women find it reassuring to know local sources of support are available, and find early planning makes life easier when the baby is born.

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Page last updated on 24 Aug 06 by Christopher Carr. Page next due for review on 22 Nov 06
© 2008 Multiple Sclerosis Society | Registered Charity 207495

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