Multiple sclerosis and pregnancyIf a woman has multiple sclerosis, there is generally no reason why she should not become pregnant. Sometimes pregnancy even has a beneficial effect on the course of the disease. However, careful planning and consultation with a neurologist are very important.
© Westend61 / Uwe Umstatter
For women with multiple sclerosis (MS), there are usually no medical concerns about pregnancy. Nevertheless, they sometimes worry: How will the pregnancy go?? Will it have an impact on the course of the disease? What does the disease mean for the unborn child?? And how will I cope when the baby arrives?
Rearingly, pregnancy tends to have a beneficial effect on the disease, based on experience and study results to date. It seems to form a kind of temporary protection against new relapses. Most pregnant women with MS feel well and are able to perform well.
Pregnancy symptoms are not much different from those of other pregnant women. Bladder symptoms, for example, which many pregnant women with MS report, occur in most women when the growing child presses on the bladder. However, if women with MS had problems controlling the bladder before pregnancy, the symptoms may be exacerbated.
If you are pregnant and have MS, it is important that you attend all preventive examinations so that possible complications can be detected at an early stage. Close collaboration between the gynecologist and the attending neurologist also provides rearance.
Allow yourself to take it easy. As for all pregnant women, a healthy lifestyle, balanced diet, exercise and adequate rest are important. It may also be advisable – in consultation with your doctor – to take folic acid and vitamin D in addition. Alcohol and nicotine should be avoided in any case.
MS relapses during pregnancy
During pregnancy, the body produces hormones and antibodies that can favorably influence the immune system and thus the course of MS. This makes disease episodes less likely, especially in the last trimester of pregnancy.
About one-third of pregnant women with MS still experience a flare-up, usually in the first few months of pregnancy. After that, the risk decreases until it increases again before birth due to stress and restlessness. If the disease flare-up has to be treated with medication, an active substance is selected for therapy that reaches the child as little as possible via the placenta in order to endanger its development as little as possible or not at all.
In general, the following rule of thumb applies: The more relapses occurred before pregnancy, the higher the probability of relapses during pregnancy.
Risks for mother and child
The pregnancy of a woman with MS is similar to that of a healthy woman. There is no increased general risk for the child.
Fortunately, based on current knowledge, most MS medications are not harmful to the unborn child. Nevertheless, the correct procedure should be discussed with the neurologist or neurologist before pregnancy if possible.
Your doctor will carefully weigh the benefits of the medicine you are taking against its risks and make a decision with you for the time of your pregnancy.
If there are no major physical limitations, a normal vaginal birth is generally possible. Multiple sclerosis alone is usually not a reason for a cesarean section.
Women with MS may be given an epidural for pain management during delivery. According to current knowledge, this has no influence on the frequency of relapses after birth.
If there is spasticity or muscle weakness in the legs, or if you are very exhausted and fatigued (fatigue), the birth may take a long time and there may not be enough strength for a vaginal birth. In this case, a Caesarean section may be advisable. Many studies report an increased rate of cesarean deliveries in pregnant women with MS. The question of how the maternity clinic of your choice deals with caesarean sections can be addressed before the birth and clarified as far as possible.
Breastfeeding is optimal for infants in many ways. Experience and study data also show that exclusive breastfeeding may even protect mothers with MS from postpartum relapses.
The World Health Organization (WHO) recommends full breastfeeding for four to six months. MS drug therapy is usually restarted after weaning. If episodes of the disease occur during breastfeeding, they are treated with cortisone. There should be a breastfeeding break of about four hours after feeding.
When deciding whether to breastfeed, you should bear in mind that breastfeeding places an additional strain on the body. Feeding with a bottle, which can then also be taken over by the partner, may be less strenuous and energy-sapping. You should therefore carefully weigh up the advantages and disadvantages of breastfeeding.
If a woman does not breastfeed, a quick restart with MS drug therapy after delivery is recommended.
The first time with the baby
The hormonal change after birth can lead to MS relapses. This seems to be independent of whether the baby is born by cesarean section or vaginally. In the first three months after birth, about 30 percent of women have a relapse, 70 percent do not. In most cases, the disease status soon returns to the pre-pregnancy level.
There is no question that the first weeks after the birth of a child are very strenuous – with or without MS. The physical change. All-around care of the baby requires a lot of strength. You may be under additional stress due to your illness. Your partner can be a great help here, as well as a well-functioning social network. It is best to talk to those around you before the birth about when and where you would like support when the child is born. Apart from that, it is helpful for all parents to create networks before and after the birth, for example through birth preparation courses, parent-child groups, baby swimming and the like.