Women are more often diagnosed with MS than men, and young women at that. Yet, for a long time, the disease’s effect on pregnancy, and vice versa, was misunderstood. In lieu of sufficient research, neurologists generally advised women with MS “not to become pregnant because it was believed that their condition made it unsafe,” says Rachel Brandstadter, MD, a neurologist at the Penn Multiple Sclerosis and Related Disorders Center.
That changed about 30 years ago with a landmark study that found most women with MS can have a safe pregnancy. The picture has grown even more encouraging in the years since. More recent studies have shown that women with MS can breastfeed and resume certain disease-modifying medications without experiencing an increased risk of relapses during the postpartum period.
Will Pregnancy Worsen My MS?
While that landmark study did finally lay to rest any concerns that pregnancy wasn’t safe for women with MS, it also found that the risk of relapse is increased in the first three to four months postpartum, especially in women who had very active MS before their pregnancies. However, a later study found that nearly half of the women with MRI-detected early post-partum MS activity had no clinical signs or symptoms.
“There’s also some data that indicates relapses during pregnancy or in the postpartum period did not seem to affect the long-term MS prognosis in most women or add to disability,” Dr. Brandstadter says.
Does MS Affect My Fertility?
MS itself does not increase the risk of infertility, Dr. Brandstadter says.
Even more, a woman with MS could safely undergo fertility treatments – ideally, with her Ob/Gyn or fertility specialist working together with her MS neurologist.
MS, on its own, also will not make a pregnancy more difficult.
Will MS Impact My Baby’s Health?
A mother’s MS will have no bearing on the health of her baby, Dr. Brandstadter says.
However, some MS treatments may increase the risk of complications with the pregnancy or the baby. There are a large number of treatment options available now that make these issues easy to avoid, which the Penn MS team is equipped to help women navigate.
If I Temporarily Stop My Disease-Modifying Therapy, How Will It Affect the Course of My MS?
“If a woman’s MS is stable, it is very reasonable to consider discontinuation of MS medication leading into pregnancy,” Dr. Brandstadter says.
Unfortunately, there isn’t a universal answer to this question because every disease-modifying medication has its own set of guidelines. Each medication also poses its own risk to a developing fetus. The decision to stop a given therapy, and when to do it, will depend on the medication’s guidelines, as well as data from exposure registries and the woman’s individual risk with her MS, Dr. Brandstadter says.
At the Penn MS and Related Disorders Center, such a plan will be tailored specifically to your condition and therapy.
Can I Breastfeed?
“Breastfeeding is encouraged,” Dr. Brandstadter says. “We know it can be beneficial for the infant and mother’s health.”
Increasing research in the area has uncovered a number of health benefits of breastfeeding, including potentially aiding the baby’s cognitive development and reducing their risk for certain allergic diseases, asthma, obesity, and type 2 diabetes. In mothers with MS, specifically, there’s also data that exclusive breastfeeding reduces the risk of postpartum MS activity, particularly in women with milder forms of MS.
How Do I Begin Family Planning?
Because of the ongoing nature of the care and the nuance of the disease, a good patient-doctor relationship is especially important for those with MS. For women considering starting a family, their neurologist is an expert guide who can help them navigate the challenging terrain ahead.
“Women should feel empowered to undertake a pregnancy, and their physician can help guide them through the process,” Dr. Brandstadter says.
Penn’s MS and Related Disorders Center offers several programs that address the condition’s unique needs at every stage of life, including the Age-Span Women’s MS Program where world-class clinicians like Dr. Brandstadter provide specialized care for all aspects of a pregnancy and ongoing education and support.