Ask the Experts: Pregnancy Questions
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Q: I am 24 yrs old and have MS. I can't walk. If I become pregnant, what should I be careful of?
Q: Is it bad to think of the possibility of having children after being diagnosed with MS?
Q: I had my first MRI in 4 years recently. It had been so long due to trying to get pregnant, being pregnant and then breastfeeding. The results of the MRI came back that I have 1 new lesion. I have had MS for 6 years and after my first initial symptoms were taken care of with steriods, no flare ups since. My doctor is wanting me to do steroids 1 day a month for 4 months then do another MRI to see if my meds are still working. But I am trying to have another baby. What are my options?
A: It is safe to take monthly steroids while trying to get pregnant. You need to make sure to schedule your steroids on the first or second day of your period, to assure that you are not pregnant at the time of the actual infusion. It is not clear from your note if you are taking any medications for MS right now. If you are, and you have one new spot in four year's time, this certainly does not mean your medications are not working for you, considering that you have been off all treatments for 4 years, as you said.
Maria Houtchens, M.D., M.Msci
January 2013
Q: I was diagnosed 2 years ago with MS. I have been off meds for one year and trying to conceive. I just had an MRI that showed a new, active lesion and my doctor wants me to go back on meds. I of course want to try and conceive and contacted a fertility doctor that agreed to do IVF on me this month. What are the risks if i conceive while i have an active lesion? is it safe, or do you suggest going back on meds asap?
A: If you have an active lesion on the MRI, it means that there is inflammation ongoing in your brain, as a result of MS. There are no risks specific to IVF in this setting, but if this inflammation does not get treated, there is increased risk of MS relapses or more lesions that may develop. Some patients chose to receive intravenous steroids once a month, for as long as they are not pregnant. These treatments can be done in conjunction with negative pregnancy tests. This may allow some patients to stay off MS medications for additional periods of time, and to continue attempts to get pregnant, while not putting themselves at higher risk of MS flare. Alternatively, other patients chose to go back on MS medications for a limited period of time, such as 6 months, and then resume their attempts to become pregnant. You should discuss all options with your neurologist to make sure your questions are answered and you are comfortable with whatever decision you make.
Maria Houtchens, M.D., M.Msci
August 2012
Q: i got diagnosed with multiple sclerosis almost a year ago and am on copaxone and trying for my first child. My doctor told me that i can stay on it throughout my pregnancy because there was no evidence of side affects nor birth affects. ...Is that true?
A: Copaxone is designated as "Pregnancy Category B" by FDA which generally means that animal studies did not show any adverse events in embryos, and data from human pregnancies also showed no adverse events. If is important to remember, however, that no drugs are completely safe in pregnancy, and should only be used if necessary for the mother's health. Pregnancy is considered to be a time when most patients with MS feel well off all MS-specific treatments. We generally do not recommend that pregnant women remain on Copaxone, or any other MS medications until the end of pregnancy. You should discuss the pros and cons of this with your neurologist, to make sure that all your questions are answered and you are comfortable with whatever decision you make.
Best of luck with your first baby.
Maria Houtchens, M.D., M.Msci
August 2012
Q: I am 25 years old. I was diagnosed with MS when I was 24, after the birth of my third child. I have three kids, is it ok to have more children?
A: It is generally safe for MS patients to go through pregnancy and to have children. However, you would need to speak with your MS doctor about your specific circumstances, especially about how stable your MS has been, your prognosis, treatment plan, and other matters.
Maria Houtchens, M.D., M.Msci
May 2012
Q: I am 25yrs old and pregnant with my second child. I was diagnosed with MS 5yrs ago. I have been experiencing numbness and tingling which started in my feet and has been working its way upward. The numbness has now reached my stomach and it makes me feel like I am having small contractions even though I am only 4 months along. Is this harmful to my baby?
A: These symptoms are not harmful to your baby, but they may indicate that you are having a problem in your spinal cord related to MS. This is concerning. I would suggest that you need to call your MS doctor right away and discuss this.
If a decision is made to use steroids to treat your symptoms, please, know that steroids are not harmful to developing baby and this would be a safe way to make sure that you are feeling better, without harming your baby in any way.
Maria Houtchens, M.D., M.Msci
April 2012
Q: I am a 28 year old who has not been diagnosed with MS yet because my spinal fluid is normal. Every other test is not. My doctor wants to treat me for MS with one of the shots. My husband and I do not have children yet and would like to have some one day. Should I wait to start treatment after I have children, or should I start and then quit after a few months when we start trying to get pregnant?
A: If all your tests but one came back positive for MS, there is a good chance this is MS. Spinal fluid is not always positive even in patients with the known diagnosis. I would suggest going on therapy as suggested, for 6 months, to see how your illness develops. If you remain well, without any flare-ups, or other problems, you may consider starting your family after that time. Whatever you decide to do, you should discuss this carefully with your MS neurologist.
Maria Houtchens, M.D., M.Msci
February 2012
Q: I am 27 years old and I just had my first baby 4 months ago. I desperately want a second one, but my husband is concerned that I will have more exacerbations if I have another child, because I haven't seemed to worsen with our daughter. Is this really something to be concerned about?
A: In general, the rate of exacerbations of MS is reduced during pregnancy and increased by about an equal amount in the months following delivery, overall little or no change. Many things have to go into your decision including a concern for later disability which might develop independently of another pregnancy. This is a common and complex question and a frank discussion with both your neurologist and obstetrician with your spouse in attendance is often helpful. Timing might be influenced by the current activity of the condition, and your MS doctor might suggest a time interval depending on the frequency of relapses, and MRI activity.
I hope this is helpful.
Arthur Safran, MD
March 2009
Q: I am due in early November with my son. He is breech and they plan to do a c-section. Are there any known complications of MS with an epidural or spinal block?
A: There is no published data about the use of epidural anesthesia with MS of which I am aware. Nevertheless, in a general sense, I would tend to not introduce foreign substances into the central nervous system when it is the subject of an autoimmune disorder. Again, there is no proof of this position of which I am aware.
Arthur Safran, MD
October 2009
Q: I am 24 yrs old and have MS. I can't walk. If I become pregnant, what should I be careful of?
A: There are no particular precautions to take. In general the chance of a exacerbation is a bit less during the pregnancy. You should consult with your obstetrician about the nature of the planned delivery, and be certain to discontinue medications at least a month before attempting to become pregnant. A visit with your neurologist soon is likely to be important.
Arthur Safran, MD
October 2009
Q: Is it bad to think of the possibility of having children after being diagnosed with MS?
A: No, it's not bad to think of having children after you have been diagnosed with MS. Many women with MS have had successful pregnancies, and beautiful babies. In fact there isn't any real reason to think that MS is bad for the infant before birth, or that the mother does any worse or better with her MS because of having been pregnant. Of course you have to be careful with medications during pregnancy—and that includes a lot of the MS medications. So you would have to review these medicines with your doctor at the start of a pregnancy.
Q: I am a 36-year-old woman recently diagnosed with MS and placed on Copaxone. I have one child, and have had four years of infertility treatments ending with several failed IVF attempts. My MS was diagnosed after the fact. Would another attempt at pregnancy be an ill-advised idea? Is there any chance that my inability to become pregnant again and the MS have anything to do with each other?
A: Regarding whether another attempt at pregnancy is ill-advised: The effects of pregnancy (not counting IVF) on MS are somewhat dependent on the specific part of the pregnancy-year under consideration. During the last three months of pregnancy there is a powerful beneficial effect on MS. The number of relapses is reduced and MRI scans appear to improve in some patients. However, the situation reverses during the first 3 months following delivery, when the risk of MS-flares is increased. The net effect of pregnancy on MS is probably neutral, or even favorable in terms of the long-terms effects.
You are also asking a more complicated question, which is "What is the effect of IVF on MS?" The answer to this question is not established. There is some data that female hormones may be helpful for MS (e.g. the Estriol study in California) but there is also some information that female sex hormones may stimulate MS. In our limited experience with this situation we have not seen any obvious worsening of MS resulting from IVF.
Your third question was about whether MS might have affected your fertility. MS does not appear to have any major overall effect on fertility. However, there are some women with MS in whom the illness might affect their fertility. That is, some women with MS have elevated levels of antibodies in their blood ("anticardiolipin antibody" or "lupus anticoagulant") that might promote miscarriages and/or infertility. These can be tested by your doctor from a blood sample, and if present, you may benefit from treatment with aspirin or other medications.