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Reviewed by the Faculty of Harvard Medical School

Multiple Sclerosis and Pregnancy

Multiple sclerosis (MS) is an incurable, progressive disease of the central nervous system that affects an estimated 333,000 Americans, two-thirds of them women, and typically strikes young adults in their 20s or 30s. If you have MS, you're probably wondering how a pregnancy might affect your health and that of your child. Although there are many unknowns about MS, including the exact cause, researchers do have some important answers for you.

First, pregnancy and childbirth don't have any negative long-term effects on women with MS. But because MS symptoms can range from mild blurring of vision to total paralysis, you'll want to consider what your degree of disability would mean to your ability to care for a baby. You should also keep in mind that the course of the disease is highly unpredictable, and that you'll need special care and support both during pregnancy and in the weeks after delivery.

It's uncommon for expectant mothers who have MS to experience worsening of central nervous system symptoms. In fact, for most women with MS, pregnancy actually seems to give some protection against disease flare-ups, but it can make them more susceptible to other health problems, including fatigue (especially during the first three months), constipation and urinary tract infections (already more frequent among women with MS). As you near term, you may also find that you are less steady on your feet, making it a good idea to install grab bars, particularly in the bathroom. An obstetrician may suggest such precautions as using a stool softener to counter constipation, regular urine cultures to detect possible infections, a change of MS medication or other measures appropriate to your case.

Labor for a woman with MS is usually handled in much the same way as for other women. Some obstetricians believe the best forms of pain relief during delivery are narcotics or Lamaze techniques, whereas others say that an epidural or general anesthesia is also safe. Women with a pronounced lack of sensation or paralysis may also be monitored closely during the ninth month in case they are unable to detect the onset of contractions or need to have labor induced after the cervix starts to open.

In the postpartum stage, research indicates that exacerbations increase in nearly 50 percent of cases, so if you've had a problem in the past with them, your chances of developing one are apt to increase. If you do get a worsening of symptoms, however, it's unlikely to be permanent. The first six months after you've given birth are the highest risk period for disease flare-ups, so you'll want to take as good care of yourself as possible. Getting enough rest and trying to avoid infections, fevers, stress and anemia can help to prevent this problem.

On the question of breast-feeding, the answer varies according to your specific case. For some women with MS, breast-feeding is too tiring, or for others who use certain medicines, such as Valium, it may not be medically recommended. Most mothers with this disease can nurse a baby, however, so discuss the topic with your obstetrician, pediatrician and neurologist before you make a final decision. Current medical information shows no elevated risk of exacerbations caused by breast-feeding.

Finally, the risk that your baby will someday develop MS is only 1 percent to 5 perecent, depending on the child's sex and which parent has the disease. The probability is highest if you — not your husband — have MS and if your baby is a girl. Although MS is not a directly inherited disorder, genetic factors are thought to play a role in some individuals. To learn more about MS or MS and pregnancy, or to locate a chapter near you, call the National Multiple Sclerosis Society at (800) FIGHT MS (344-4867), or visit their Web site at www.nmss.org.

Last updated August 4, 2006




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