Multiple sclerosis and pregnancy
Published 9 Dec 2020 • By Doriany Samair
Multiple sclerosis (MS) is a neurological autoimmune disease that affects more women (75%) than men. These women are often young (between 20 and 40 years old) and therefore of childbearing age. In the past, pregnancy was forbidden for women with MS, but now they are able to become pregnant with peace of mind.
Can someone with MS consider pregnancy? Can MS affect one's ability to get pregnant? Can assisted reproductive technology (ART) be considered with MS? What about poorly controlled MS or ongoing treatment? Can treatment be stopped? What happens during childbirth in MS?
We tell you everything in our article!
Planning the pregnancy and controlling flare-ups
Pregnancy is not contraindicated in women with multiple sclerosis. Indeed, the disease itself has no repercussions on women's fertility, the development of the foetus or even childbirth. A woman can still consider having children even if she has the MS.
Generally speaking, women with MS do not have reduced fertility. However, some studies have highlighted a high prevalence of sexual dysfunction in men (almost 65%) and women (40%) with MS, compared to 10% in the general population. In women we can cite the presence of polycystic ovaries or in men, a problem with sperm. As a result, the use of assisted reproductive technology (ART) is quite possible, as it is for any other couple. It should be remembered that these methods serve to create the most favourable conditions for fertilisation (hormonal therapy to stimulate ovulation, artificial insemination, in vitro fertilisation (IVF), etc.).
The different forms of multiple sclerosis evolve through episodes of relapses and remissions. A pregnancy should be planned with one's medical team and neurologist: a period of time should be chosen when flare-ups occur less frequently, in order to avoid symptoms such as increased spasticity or depression, which can become more pronounced in early pregnancy.
Is it necessary to stop background treatment?
It is imperative to seek the advice of a neurologist to consider stopping treatment. The doctor will judge whether or not the treatment is harmful for the baby. Generally speaking, the older injectable drugs (for which we have the benefit of hindsight) can be maintained in the early stages of pregnancy. The idea is to stop contraception first, and when the pregnancy begins, to stop background treatment (immunomodulatory drugs) following a doctor's advice and supervision. These treatments may sometimes be maintained if the MS is very active.
In addition, immunosuppressive treatments such as CYCLOPHOSPHAMIDE or MITOXANTRONE should be stopped when pregnancy is being considered. A delay of 3 to 6 months is recommended between the discontinuation of treatment and the beginning of a pregnancy.
It should be noted that it is recommended to stop NATALIZUMAB 3 months before stopping contraception, compared to 2 months for stopping FINGOLIMOD. Indeed, these molecules have been shown to be teratogenic (causing birth defects) in animals.
All these risks are evaluated by the neurologist who will make the decision with the patient.
Will I pass on MS to my child?
Children born to mothers with MS have a 2-3% higher risk of developing MS than the general population. In reality, inheritance is based on the inheritance of an autoimmune tendency, rather than a specific MS gene. This auto-immune tendency relates to several diseases affecting the tolerance of the immune system, called autoimmune diseases.
Living well during pregnancy
Pregnancy in a woman with MS is not considered "at risk", so there are no special precautions to be taken.
Which changes to the body can be expected?
It is common for spasticity (an increase in muscle tone, with symptoms such as spasms, muscle stiffness or contractions) to increase in early pregnancy. This is an important symptom, predominantly in the bladder for a woman with MS and sometimes in the lower and upper limbs, which can intensify in early pregnancy. Sometimes, if the abdominal wall is affected, spasticity can cause contractions of the abdomen which can be treated with painkillers. These contractions are not in the uterus but in the abdomen.
What about relapses?
Risks of flare-ups while pregnant are very low, especially in women who were 'stable' before the pregnancy. In fact, this observation can be verified as early as the first trimester of pregnancy and has been supported by numerous scientific studies. During pregnancy, there is a change in the body's immune response, making it more tolerant to avoid rejection of the foetus. This phenomenon has a more significant impact in the last trimester of pregnancy where a 70% reduction in relapses is observed compared to the year before pregnancy.
Furthermore, the neurological degeneration to which patients with MS are exposed does not worsen or accelerate with pregnancy. The evolution of the disease is inevitable, but pregnancy does not increase the risk of disability.
What to do in the case of relapses during pregnancy?
As a precaution, it is best to avoid corticosteroids during pregnancy. The risk of birth defects has not been shown to be greater than in the general population. Usual corticosteroid injections can be given, and a flare-up can be followed up in hospital if necessary. But overall, the use of corticosteroids does not present any risk for the mother or the child. A neonatal check-up will be offered to the newborn (diuresis, glycaemia, weight) if corticosteroids were used close to the time of birth.
Childbirth: What to expect? What's to follow?
Apart from informing the obstetric team about MS, there are no special precautions that need to be taken during childbirth. Epidural, C-section or any other obstetrical procedural can be considered as for any other pregnancy. If necessary, the delivering physician or midwife may try to avoid a long labour or certain uncomfortable and painful positions.
Breastfeeding and resuming treatment
Breastfeeding is not contraindicated in cases of multiple sclerosis.
Multiple sclerosis after childbirth?
Studies show that 20-30% of women have a relapse within 3 months after giving birth. This should be discussed with the neurologist who will be able to assess the risk, as these postpartum flare-ups can be prevented with medication.
Overall, pregnancy and MS are not incompatible. In the end, it is a matter of planning the event as much as possible for ideal care and carrying the pregnancy to term with peace of mind.
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