Multiple Sclerosis (MS) is a disease that can affect many areas of a person’s life—not the least of which is pregnancy.
A few years ago I had a patient who had recently been diagnosed with MS. She was a young woman in her thirties who had not yet had children. As she began treatment with her neurologist, one of her first questions was: what’s going to happen when I want to get pregnant?
And the truth is, it’s a complicated issue. The answer is different for everyone. But there are certain things that are important to know. In this post I’m going to discuss some of the issues surrounding MS and pregnancy.
Did you know there are approximately 100,000 Canadians living with MS?1 As women, our risk is the highest: MS is four times as likely to occur in women. Since MS is most often diagnosed in young adults, people aged 15-40, that means it typically first appears during a woman’s child-bearing years2.
MS is an autoimmune condition of the central nervous system that is considered a progressive disease. However, the severity and rate of that progression varies widely: some people may only experience occasional flares of their MS symptoms punctuating it as an otherwise stable disease.2
Symptoms of MS can include: vision changes, muscle weakness, balance problems, unusual sensations in the limbs or face, dizziness, bladder problems, fatigue, and pain.
Sometimes MS can be a tricky disease to diagnose. But once a diagnosis is made, it’s important to start treatment right away. There are a variety of medications that can be used as disease-modifying therapy, and people living with MS today have more treatment options than ever. Early and aggressive treatment has been shown, through research, to slow disease progression and decrease relapse rates. There are many different possible treatment options for MS, and they all carry different risks and benefits.
First, it's important to know that MS itself does not affect a woman's fertility. When it comes to pregnancy, the most important thing to do is speak with your doctor. Start a conversation when you first start considering pregnancy so you can understand the issues up front. Everyone is different, and people with MS have varying degrees of severity and different types of disease, so the recommendations for you and pregnancy will be highly individual.
That said, a few things are worth considering when it comes to MS and pregnancy. Women need to stop their DMTs (disease modifying therapies) before to trying to conceive, so the medication can be completely cleared from their systems before pregnancy. However, that clear out period varies, depending on the exact medication being used. Some treatment options don’t metabolize in the liver, and only require a 24-hour washout period.
Although DMTs cannot be continued through pregnancy, there are some medications your doctor may recommend during pregnancy if your disease is particularly severe—treatments that can treat acute attacks and lessen symptoms. Again, all decisions will be highly individual, and will be made together with your team of doctors.
Research has shown that pregnancy does not appear to cause more disability in the long term for women who have MS. In fact, during pregnancy, many women with MS tend to feel better and experience fewer relapses. That improvement is short lived, however, because it's an effect of pregnancy hormones.
While all of this may sound complicated and perhaps even scary, the worst thing you could do is avoid talking to your doctor—either to get assessed and diagnosed in the first place, or to begin treatment at an early stage. Early, aggressive treatment has been shown to make a significant difference for patients with MS. Denial and avoidance are common (and understandable) reactions to a diagnosis of chronic illness like multiple sclerosis. But those reactions can be harmful to your long term health.
Since MS usually hits during child-bearing age, it can impact your family planning. But the exact shape of that impact depends on many things. If you have MS and you’re even thinking about conceiving, book an appointment with your doctor to discuss all the issues and create a plan that will work for you and your family.
For more details about the information included above please visit: MS Society of Canada.