Multiple sclerosis (MS) most often starts between the ages of 20 and 40, which are also the peak childbearing and child-rearing years. Because MS is a chronic and progressive condition, it's natural to wonder how it might affect your ability to get pregnant, give birth to a healthy baby, and care for that child. You might also worry about how pregnancy will change your MS symptoms and progression.
More than half of the people with MS surveyed said it affected their decision to have children. And 14% of them ultimately decided not to have kids because of their condition.
If you're weighing the pros and cons of parenthood, know that most people with MS can conceive and have a safe and healthy pregnancy. There's no reason to give up on starting a family if that's your plan. But if you choose not to get pregnant because of MS or for other reasons, you do have options.
What to Consider Before You Start a Family
Does MS affect fertility?
Some studies show that fertility and pregnancy rates are the same in people with and without MS. Yet MS symptoms and medications could affect your sex drive. If your partner has MS, it could affect their ability to get an erection or ejaculate.
Some people decide to delay family plans as they adjust to their MS treatment. Waiting too long could make it harder to conceive.
How will MS affect my unborn baby?
MS shouldn't affect your baby's growth in the womb. "Unlike other autoimmune conditions, antibodies are not known to transfer through pregnancy," says Suma Shah, MD, an associate professor of neurology at Duke University School of Medicine.
You're just as likely to have a healthy baby as someone without MS. MS doesn't raise your odds of a high-risk pregnancy. It also doesn't make you more likely to have complications such as a miscarriage, stillbirth, or preeclampsia, or to have a baby born with birth defects. However, there is a very small chance your baby could be small for their age. And because some of the medicines that treat MS are risky to take during pregnancy, your doctor may ask you to stop them until after you deliver.
What are the odds of relapse during pregnancy?
"Pregnancy tends to have a protective effect on multiple sclerosis," says Shah. Your risk of relapse actually is lower, especially during the last trimester. That's because your immune system calms down to avoid rejecting your growing baby.
The risk of a relapse goes up three months after your baby's birth because of changes in your hormone levels. But your condition should return to its prepregnancy state within six months after your baby's birth.
How does pregnancy affect MS treatment?
Some of the medicines that treat MS aren't safe to take during pregnancy because they could harm your growing baby. Your doctor will weigh the risks of taking the medicine against the need to control your symptoms.
None of the disease-modifying therapies (DMTs) for MS are FDA-approved for use during pregnancy, but some are safer than others. Glatiramer acetate (Copaxone) and interferon beta may be OK to take during the first trimester. Alemtuzumab (Lemtrada), natalizumab (Tysabri), and teriflunomide (Aubagio) aren't safe because they could harm your growing baby.
Your doctor may recommend a washout period. That's when you stop taking your medicine for a few weeks or months before you conceive to give it time to leave your body. Some medicines cause withdrawal symptoms if you stop them too quickly.
How might changing treatment affect symptoms and disease progression?
Many people with MS don't need treatment because pregnancy naturally quiets their disease. Your symptoms might even improve, especially during the third trimester. But there is a risk of relapse if you stop taking your medicine, especially if your MS was active before you conceived.
A good approach is to get your MS stable for at least a year on a DMT before you get pregnant. "Being off treatment may be an option once [you're] pregnant, due to the protective effects of pregnancy," says Shah. Your doctor will time your treatment before and after pregnancy so that you're protected against relapses but still able to start a family.
Even if you do relapse, it shouldn't affect your disease progression. Pregnancy doesn't seem to have any long-term effects on MS.
Will my children have MS if I have it?
"If a parent has MS, the child's risk of developing the disease does increase," says Shah. Their risk is only slightly higher, though. So it's not guaranteed that your child will have MS because you have it.
On average, 3 out of every 1,000 people in the US have MS. Among children who have a parent with MS, the risk is 3 or 4 out of 100. You can reduce your child's risk if you take vitamin D during pregnancy and don't expose them to tobacco smoke.
How will MS affect my pregnancy?
MS can make some pregnancy symptoms worse, and vice versa. Tiredness is a common symptom of both pregnancy and MS. Increased heat sensitivity and trouble sleeping while you're pregnant can worsen MS fatigue. Late in pregnancy, as your baby grows, it may be harder to walk. If the weight of your belly makes you more unsteady, it could increase your risk for a fall.
Questions to Consider About Parenting With MS
What are the challenges of being a parent with MS?
Having MS only adds to the challenges facing new parents. The risk of relapsing after you deliver, juggling MS symptoms with the demands of a newborn, and balancing the need to breastfeed and restart your medication can all weigh on you.
Add symptoms such as fatigue and trouble walking into the mix, and parenting becomes even harder. Having MS puts you at risk for depression, which is already a risk during the newborn period. Your doctor can help you manage symptoms so that you can focus on your baby.
How do you parent when MS is progressive?
In progressive MS, disability steadily worsens without any remissions. The symptoms can make parenting even more of a challenge. Give yourself enough time to rest. Ask friends and family to help with your baby so that you can take breaks and nap.
As your child grows, choose activities that fit your abilities. For example, you might do a puzzle or board game together instead of playing outside when you're tired.
How can I deal with "mom guilt"?
Parenthood already comes with a lot of worries and guilt. MS adds to those feelings. You worry that your illness will stop you from being a good parent. You feel guilty when your partner has to take over childcare because you don't feel up to it.
Remember that self-care is important to your well-being and ability to parent. You'll have more energy to care for your child if you rest and recharge. When your child is old enough, explain why you can't always be around when they want you. Then, they'll be a lot more understanding when you do have to take breaks.
How do I balance MS and parenting?
Parenting is always a balancing act, even when you don't have a chronic illness. Try to structure your day around MS symptoms. For example, put some ingredients into a slow cooker in the morning so you don't have to prepare dinner. Let your children watch TV or play on their screens to give you time to nap. Ask for help from your partner, neighbors, family, or friends when you need it.
Questions to Consider When Choosing an Alternate Path Than Parenthood
How do I deal with guilt, loss, or judgment if I decide to be child-free?
The decision to have children is between you and your partner (if you're in a relationship). Choosing not to start a family due to MS might feel like a failure, but it's not. You have the right to do what's best for you. Know that life can be just as fulfilling without children as it is with them.
How do I know if I'm making a bad decision?
There are no bad decisions when you make them for yourself and your family. If you have doubts about whether to start a family, talk to a mental health professional. A therapist, psychologist, or counselor can help you sort through your emotions.
What are some alternate paths to parenthood?
MS shouldn't stop you from getting pregnant and carrying a healthy baby to term, if that's your goal. But if you can't or don't choose to get pregnant, you do have other options. You might try in vitro fertilization (IVF) if you can't conceive naturally. There is a higher risk of an MS relapse while on IVF medicines, but that's something your doctor can discuss with you.
Another choice is to adopt a child. Having a disability shouldn't disqualify you from adopting. Depending on your health and abilities, an older child might be easier to care for than a newborn.
