Women are three to four times more likely than men to develop multiple sclerosis (MS), a chronic autoimmune disease that affects the brain and spinal cord. Most women with MS are first diagnosed during childbearing years, making family planning an important consideration. If this applies to you, Duke neurologist Suma Shah, MD, who specializes in MS and pregnancy, offers advice to help you plan for the future.
Having MS Does Not Mean You Can’t Have Children
Although women with MS were once told they couldn’t or shouldn’t have children, that’s no longer true,. Shah said. Research shows that MS does not make it more difficult to get pregnant, and it does not increase the risk of pregnancy complications. However, a child’s risk of developing MS later in life increases if a parent has certain types of MS.
Start Family Planning Now
Even if you’re not ready to have a baby right now, you can start thinking about the experience you want. When do I want to get pregnant? Do I want more than one child? Do I want to breastfeed? Discuss these important questions with your neurologist and ob-gyn early on. That way you can work toward a period of MS symptom and disease stability before conceiving to lower your risk of relapse during and after pregnancy.
“If you have highly active disease, meaning lots of flares, and medications haven't yet kicked in, it may not be the best time to get pregnant,” Shah said. “You could experience some level of disability as a new parent, and that's the last thing we want.”
What to Expect When You’re Expecting: MS Edition
According to Dr. Shah, existing disease-modifying therapies (DMTs) that reduce the frequency and severity of MS relapses could harm a developing fetus. Doctors call this “teratogenicity.” Depending on your risk profile, your doctors may recommend pausing DMTs during pregnancy or switching to medications with the lowest risk.
Fortunately, many women with MS experience complete remission while pregnant. “Our bodies automatically turn down the immune system during pregnancy so that the baby doesn't get attacked by it,” Shah said. “As a result, autoimmune conditions are often less active during pregnancy as a way to protect the developing child.”
The Post-Partum Period and Breastfeeding
While MS symptoms typically improve during pregnancy, they tend to rebound in the first three months after birth. “Because of what we know about that increased postpartum relapse rate, we need to have a plan in place so that the new mom has every opportunity to be as healthy as possible in that high-risk state,” Shah said. She recommends seeing your neurologist early in the third trimester to discuss whether to restart DMTs and when. Shah usually recommends resuming DMTs within four weeks after birth to help curb the rebound effect. Your doctors will work with you to adjust your medications. “Breastfeeding is absolutely a possibility, but we need to make sure we're using the right medications that have the least risk of transfer to baby,” she said.
Where You Receive Care Matters
According to Shah, women with MS who are considering having children someday should seek care at a center like Duke sooner rather than later. Our care team brings together neurologists and perinatologists (experts in high-risk pregnancy) as well as other specialists who routinely care for women with MS. We work together to offer the best treatment recommendations and help you grow your family.
“In the years that I've been providing pregnancy counseling for patients living with MS, I have been inspired by the patients who've come back with their stories of not just a healthy pregnancy, but healthy children born to them,” Shah said. “That is the large majority of patients that we guide through pregnancy.”