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National MS Society
Information Sourcebook
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Pregnancy
MS is more prevalent in women of childbearing age than in any other group. When
young women receive a diagnosis of MS, they frequently have questions about the
effects of the disease on childbearing and vice versa. Studies undertaken over the
past several decades allow health professionals to provide answers to some of
these questions.
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Effects of MS on Fertility: There is no evidence that MS impairs fertility or leads
to an increased number of spontaneous abortions, stillbirths, or congenital
malformations. Several studies of large numbers of women have repeatedly
demonstrated that pregnancy, labor, delivery, and the incidence of fetal
complications are no different in women who have MS than in control groups
without the disease.
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Effects of Pregnancy on MS: Prior to 1950, most women with MS were
counseled to avoid pregnancy because of the belief that it might make their MS
worse. Over the past 40 years, many studies have been done in hundreds of
women with MS and they have almost uniformly reached the opposite
conclusion. Pregnancy appears to have a relatively protective effect on women
with MS. The number of MS exacerbations is reduced during pregnancy,
especially in the second and third trimesters. An exacerbation—also known as an
attack, relapse, or flare—is a sudden worsening of an MS symptom or
symptoms, or the appearance of new symptoms, which lasts at least 24 hours
and is separated from a previous exacerbation by at least one month.
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Effects in the Postpartum Period: Exacerbation rates may rise in the first three
to six months postpartum, and the risk of a relapse in the postpartum period is
estimated to be 20-40%. These relapses do not appear to contribute to increased
long-term disability. In the studies with long-term follow-up of women with MS
who had children, no increased disability as a result of pregnancy was found.
Pregnancy is known to be associated with an increase in a number of circulating
proteins and other factors that are natural immunosuppressants. Additionally,
levels of natural corticosteroids are higher in pregnant than non-pregnant
women. These may be some of the reasons why women with MS tend to do well
during pregnancy.
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Medical Management During Pregnancy, Delivery, and Postpartum: Women
who are taking any of the disease-modifying drugs—Avonex®, Betaseron®,
Rebif®, Copaxone®, or Novantrone®—should discuss their plan to become
pregnant with their prescribing physician. The disease-modifying drugs are not
recommended during breastfeeding because it is not known if they are excreted
in breast milk. A woman should also review any other medications she is taking
with her neurologist and obstetrician in order to identify those that are safe during
pregnancy and breastfeeding.
Studies have indicated no increased risk of relapse of MS associated with
breastfeeding. Women with MS usually need no special gynecologic care during
pregnancy. Labor and delivery are usually the same as in other women and no
special management is needed. General anesthesia and anesthesia injected
directly into the epidural space of spine seem to be well tolerated by women in
labor.
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Use of Steroid Medications: Women who use steroids for acute MS
exacerbations may continue to use them during pregnancy. The use of
prednisone in a woman who is breastfeeding should be carefully monitored.
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Special Concerns for the Pregnant Patient With MS: Women who have gait
difficulties may find these get worse during late pregnancy as they become
heavier and their center of gravity shifts. Increased use of assistive devices to
walk or use of a wheelchair may be advisable at these times. Bladder and bowel
problems, which occur in all pregnant women, may be aggravated in women with
MS who have pre-existing urinary or bowel dysfunction. MS patients may also be
more subject to fatigue.
In general, pregnancy does not appear to affect the long-term clinical course of MS.
Women who have MS and wish to have a family can usually do so successfully with
the assistance of their neurologist and obstetrician.
See also…
Sourcebook
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Anesthesia
Exacerbation
Genetics
Hormones
Prognosis
Umbilical Cord Blood
Donation
Society Web Resource
• Spotlight: MS and Pregnancy
www.nationalmssociety.org/Pregnancy
Information for Women with MS to Share with Their Physicians
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Pregnancy, Delivery, and the Post Partum Period (PDF)
www.nationalmssociety.org/PregnancyInfo
Clinical Bulletin for Healthcare Professionals
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Reproductive Issues in Persons with Multiple Sclerosis
www.nationalmssociety.org/ClinicalBulletins
Books
Kalb R. (ed.) Multiple Sclerosis: The Questions You Have; The Answers You Need
(3rd ed.). New York: Demos Medical Publishing, 2004.
—Ch. 13 Fertility, Pregnancy, and Childbirth
Kalb R. (ed.). Multiple Sclerosis: A Guide for Families (3rd ed.). New York: Demos
Medical Publishing, 2005.
—Ch. 5 Fertility, Pregnancy, and Childbirth
Rogers J. The Disabled Woman's Guide to Pregnancy and Birth. New York: Demos
Medical Publishing, 2005.
The National Multiple Sclerosis Society is proud to be a source of information about multiple
sclerosis. Our comments are based on professional advice, published experience, and expert
opinion, but do not represent individual therapeutic recommendations or prescription. For specific
information and advice, consult your personal physician.
To contact your chapter, call 1-800-FIGHT-MS (1-800-344-4867) or visit the National MS Society
web site: www.nationalmssociety.org.
© 2006 The National Multiple Sclerosis Society. All rights reserved.
Last updated July 2006