Ask the Experts: Pregnancy
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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 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.
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.
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.
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.