Dispelling myths about pregnancy in multiple sclerosis

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Dispelling myths about pregnancy in multiple sclerosis

Hereditary, delivery risks lower than many think, UW Medicine neurologist says
Katherine Evans

Dr. Annette Wundes is a UW assistant professor of neurology and adjunct assistant professor of rehabilitation medicine, and practices at the UW Medicine Multiple Sclerosis Center located at Northwest Hospital. She recently sat down for a Q&A about common concerns she hears from pregnant women who have multiple sclerosis, often called MS.

Q. Are there some common fears or misconceptions that you find MS patients have about pregnancy?

A. A lot of my patients have unrealistic concerns when it comes to pregnancy. In particular, I’m surprised by how high they think the risk is of passing MS to their child. Some think it’s 50 percent, others believe that it is 100 percent certain their child will get MS. They are relieved to learn that it is extremely likely that their child will not get MS. MS is not an inherited disease. The risk of the child contracting MS is higher compared to the general population, but it is still very low — around 2 to 5 percent. This means that 95 to 98 children out of 100 born to mothers who have MS will not get MS themselves.

The other big concern my patients tend to have relates to how having a baby may affect their MS symptoms. Overall, the long-term prognosis of MS is not worsened by having children. The patient’s risk of experiencing an MS relapse actually decreases during pregnancy and is at its lowest in the third trimester. After delivery, however, there is a 3- to 6-month window during which the risk of MS relapse is increased.

Q. Are there any special concerns or complications that pregnant women who have MS should know about?

A. MS does not negatively affect a woman’s ability to conceive or bear children. However, some symptoms may increase when a woman with MS becomes pregnant. Women with MS tend to have issues with their bladder function, which can be exacerbated as the growing fetus puts pressure on the bladder. Fatigue is a common symptom in both MS and pregnancy, so women with MS who become pregnant may experience more overall fatigue than they did before they became pregnant, and it may be more intense for them than it would be for a pregnant woman who doesn’t have MS.
Q. Are MS pregnancies considered to be “high risk?”

A. No, MS does not automatically make a pregnancy “high risk.” Most women with MS are able to carry and deliver a healthy baby. They usually have a normal labor and delivery. Epidural anesthesia is considered to be safe for them, and none of the usual pain relieving medications for labor are off limits. All decisions when it comes to the method of delivery should be based on the patient’s needs, not just their MS diagnosis. I always work to have a close collaboration with the patient’s obstetrics-gynecology provider, so that I can answer any questions about MS that come up as the pregnancy progresses.
Q. What about taking medication for MS while pregnant?

A. There are no generally accepted guidelines for MS management when it comes to pregnancy. Most MS medications are stopped one to three months before a woman decides to become pregnant, depending on the severity of their MS and the specific medications they are taking. We don’t order MRIs or use contrast dyes, and for symptom management such as depression or nerve pain, we may switch to medications that are known to be safe for pregnant women.
Q. Can women with MS breastfeed?

A. I get a lot of questions about breastfeeding with MS. Breastfeeding seems to be safe. No studies have suggested that there is a negative effect, and breastfeeding not supplemented by formula may even offer the mother some benefit against MS relapses.

Women usually do not resume their preventative MS medication while breastfeeding. If needed, we provide additional protection against MS relapse in the postpartum setting while breastfeeding, such as medications that do not pass into the breast milk at all or only in small amounts that are quickly eliminated from the woman’s body.