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Symptom and Relapse Management During Pregnancy

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Many of the medications used to manage MS symptoms are Category C drugs (e.g., baclofen for spasticity; fluoxetine for depression; solifenacin succinate for bladder management) and should not be used during pregnancy; other management strategies should be implemented (Coyle, 2016; Bove et al., 2014).

MS-related fatigue may augment the normal fatigue of pregnancy; bladder and bowel symptoms may increase, including a higher risk of urinary tract infections and increased constipation; balance problems may worsen with weight gain.

Relapses severe enough to warrant treatment can be safely managed with a short course of corticosteroids after the first trimester. Methylprednisolone is the preferred drug because it is metabolized before crossing the placenta (Coyle, 2016; Bove et al., 2014; Ferrero et al., 2004). IVIG is safe for use during pregnancy and may provide some benefit (Coyle, 2016; Bove et al., 2014; Ferrero et al., 2004).

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