Multiple sclerosis (MS) is a chronic degenerative disease that occurs three times more often in women as in men. The disease is often diagnosed during women’s childbearing years, which can increase anxieties related to childbearing. Women are often concerned they may not be able to get or remain pregnant, bear healthy children or take care of a child while managing a chronic disease.
Many women also worry that pregnancy, childbirth, and even parenting may adversely affect their health once they have been diagnosed with MS. One survey found more than one-third of women with MS had decided not to have children or to change the timing of their plans to have children.
Women with MS Frequently Have Healthy Pregnancies
While there are certain unique challenges women with MS may face if they choose to have children, they often enjoy uncomplicated pregnancies and childbirths. “My doctor was very supportive about my desire to get pregnant and would definitely be open to my pursuing more pregnancies if that’s what I wanted,” said Lindsey, a woman who was diagnosed with MS at the age of 25, a few years before she began considering starting a family.
According to Dr. Erkan Buyuk, a Reproductive Endocrinologist at Reproductive Medicine Associates of New York, Mount Sinai Hospital, MS does not prevent pregnancies or increase the risk of unhealthy pregnancies. Open communication, a strong support system, and the development of a plan for before, during, and after pregnancy are important things to keep in mind for all women who are considering pregnancy. However, these assets are particularly important for women living with MS.
Coming up with a Plan for Before, During and After Pregnancy
There are several specific things to consider when you are developing a plan to make your pregnancy as easy on you as possible. Here are 4 of them.
- What does pregnancy mean for taking your medications? Certain MS drugs can be unsafe during pregnancy and during breastfeeding. MS treatments have a pregnancy and lactation section within their product labels, which aid in making individual choices for women with MS. It is important to work with your doctor to ensure you are doing everything possible to increase the odds of a healthy pregnancy and child while also managing your MS.
- How will you feel when you’re pregnant if you have MS? Many women may experience fewer relapses while they are pregnant because pregnancy can sometimes protect them from flares. Nonetheless, women with MS who are pregnant may not all experience relief. Lindsey, for instance, did not notice much of a change in terms of her MS while she was pregnant. “I think because of where I was in the progression of the disease, pregnancy did not really affect my symptoms,” Lindsey says. Dr. Buyuk reiterates this idea, saying, “how women were doing before they were pregnant is the best predictor of how they will feel during and after pregnancy.”
Because fatigue is common for those with MS in general, and is also common during pregnancy, planning ways to cope with fatigue can make pregnancy and parenting easier as well. For example, asking for help from people in your support network may help you preserve your energy. If there are activities you know help to restore your energy, you should also think about how to incorporate those things in your routine in a regular way as you navigate pregnancy and parenting.
- What will happen after pregnancy? Relapses following pregnancy occur in about a third of women with MS, so it’s important for these women to understand while they may have fewer relapses while pregnant, more frequent relapses will likely return three to six months post-partum. “Women with MS tend to have fewer relapses during their third trimester,” says Dr. Buyuk, “but they will often experience more relapses soon after childbirth, likely because of the dramatic change in hormones that occurs during this time.”
Breastfeeding is another post-partum issue to consider. As mentioned previously, all MS medications have a pregnancy and lactation section within the product labeling. Women with MS are encouraged to think about whether breastfeeding is something they may be interested in and if they are, to discuss their treatment plan with their healthcare provider.
Post-partum depression is a common complication associated with pregnancy and childbearing, and women with MS are at a heightened risk. It is therefore critical they be particularly aware of how they are feeling following pregnancy and that they talk to their healthcare providers if they have signs of depression so that these issues can be quickly and appropriately addressed.
- How will my care routine change? Pregnancy means going to the doctor more frequently for checkups. However, pregnant women with MS also require coordinated care among different healthcare professionals. This is to ensure each specialist has the proper information to provide their patient with the care she needs and that the best clinical decisions are made.
For example, women with MS may have decreased pelvic sensation and may struggle to push during labor, making cesarean delivery more likely. In those cases, anesthesiologists need to collaborate with the patient’s other doctors to determine the best course of action regarding pain management. Dr. Buyuk highlights there is also the need for communication between neurologists and the doctors focused on pregnancy: “We need to work with the patient’s full care team to ensure the pregnancy goes as smoothly as possible in all regards.”
It is common for women with MS to start families, and MS does not specifically interfere with pregnancy or affect the baby. Women with MS who are interested in getting pregnant should speak to their doctor to begin planning for how to best approach pregnancy, childbirth, and the postpartum period. According to Lindsey, it is important to listen to your body throughout the process and take care of yourself. “You know your body best,” she says, “so you have to speak up and let your doctor know when how you’re feeling so that you can get the care you need.”
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