Multiple sclerosis (MS) doesn’t need to stop you from starting a family.
“The good news is that it is absolutely possible to have a healthy and successful pregnancy while managing MS,” says Haylea Sweat Patrick, MD, a board-certified maternal and fetal medicine specialist at RWJBH Medical Group in Jersey City, NJ. “You can expect the same symptoms, discomforts, and excitement as anyone else preparing to expand their family.”
Your pregnancy probably won’t make your MS symptoms worse. If you have relapsing remitting multiple sclerosis (RRMS), you’re less likely to have a relapse while you’re expecting a baby.
Here’s a closer look at what could happen during each stage of your pregnancy.
Managing MS Before Pregnancy
As soon as you decide you want to start a family, schedule a preconception counseling visit with your OB/GYN. You and your doctor can discuss:
- Your health history
- Any recent flares
- Your ongoing MS symptoms
- Current medications you take
Some MS treatments aren’t safe to take while you’re pregnant because they could harm your baby. Talking to your doctor before you’re pregnant gives them time to adjust your medications and make sure your MS symptoms are managed.
“Ideally, MS should be well-controlled on a pregnancy-compatible regimen for at least six months prior to conceiving,” says Patrick.
If you have lots of flares or your treatments aren’t working well, your doctor may suggest that you hold off on trying to get pregnant until your health improves.
MS During Your First Trimester
During the first three months of pregnancy, you’ll have the usual OB/GYN visits, ultrasounds, and lab tests like everyone who’s expecting. These help make sure that your baby is growing well.
You can also expect:
A bigger care team
Your OB/GYN and neurologist will work together to support you. In some cases, you might also see a maternal-fetal medicine physician (high-risk pregnancy specialist).
Overlapping symptoms
You may have fatigue, nausea, and some MS-related symptoms, such as weakness or sensory changes. “These symptoms may overlap with those of normal pregnancy and can sometimes be confusing,” says Anushka Chelliah, MD, a board-certified maternal-fetal medicine specialist at Pediatrix Medical Group in Houston, Texas.
Fewer MS relapses
Pregnancy releases a flood of estrogen in your body. That helps keep your immune cells from attacking your central nervous system. As a result, you can probably expect fewer relapses.
Treatment changes
Your doctor might suggest that you stop some or all of your MS medications. Sometimes it’s because your symptoms go away and you don’t need treatment for a while. Your doctor will also want to make sure that you don’t take a drug that could affect your growing baby.
For instance, disease-modifying treatments (DMTs) that help manage MS flares usually aren’t safe to take during pregnancy. If you get pregnant while taking a DMT, your doctor will probably do an extra ultrasound to make sure your baby is OK. They’ll likely advise you to stop taking it and switch you to a drug with fewer risks.
MS During Your Second Trimester
Your second trimester is “typically the period of most stability,” says Chelliah. “Your immune system is suppressed, and your body is in an anti-inflammatory state. There are much fewer relapses during this time.”
You can also expect:
Extra support for your symptoms
Some common early pregnancy symptoms can overlap with or worsen your MS symptoms. These include:
- Heat sensitivity
- Insomnia (trouble sleeping)
- Bladder issues (such as needing to pee often or not being able to hold your pee)
Tell your doctor about any symptoms you have. They can help you manage them. Some things you might try include:
- A support group
- Therapy (talking to a counselor)
- Physical therapy
Steroid treatment
Relapses can still happen. If you have a mild flare, you might not need treatment. But if your relapse is severe, your doctor may prescribe a course of high-dose corticosteroids. Because they can affect your baby, doctors try not to give them unless they have to, and usually only in the second and third trimesters.
MS During Your Third Trimester
It’s common for MS symptoms to get better or stay steady in the third trimester.
The symptoms you might be most aware of include:
- Painful, tender joints
- Finding it hard to move around
- Balance issues
But these could be due to your pregnancy and aren’t always MS-related.
You can also expect:
More doctor visits
During this time, “some additional ultrasounds and monitoring may be recommended,” says Patrick. The type of extra care you have will depend on how well your MS has been controlled during your pregnancy and any other health issues that concern your doctor.
A postpartum plan
Right after birth is a high-risk time for MS to flare. “It’s important to work with your neurologist towards the end of pregnancy to make a postpartum treatment plan,” says Patrick.
Talk to your doctor about how and when to restart your MS treatments and ways that you can get extra support once your new baby arrives.
How MS Can Affect Your Delivery
MS doesn’t increase your risk of:
- Premature birth
- Stillbirth
- Miscarriage
- Your baby being born with abnormalities
But you may be more likely to have:
- A smaller baby than expected
- Trouble pushing out your baby during labor
- A C-section
A birth plan can take your MS symptoms into account. Your care team can help make suggestions. For instance, getting an epidural (anesthesia you get in a shot near your spinal cord) soon after labor starts could help you manage fatigue.
MS After Your Baby Arrives
After your baby is born, it can help to:
Know how you can manage a relapse
Your hormones go through a big shift once you deliver your baby, and your risk for an MS relapse goes back up. In the first three months after birth, about 13% of people have a relapse.
This risk lasts about six to nine months, so talk to your doctor about what you can do to manage new or worsening MS symptoms.
Be flexible when it comes to feeding your baby
Let your doctor know if you plan to breastfeed. That can affect the treatments they prescribe. Some MS medications can get into your breastmilk and harm your baby.
It’s important to note that breastfeeding won’t worsen your MS symptoms, and your baby can’t “catch” MS through your breastmilk.
If you’re worried that your MS symptoms will make it hard for you to nurse, try the following:
- Pump and freeze your breast milk on days that you feel good.
- Switch between nursing and bottle feeding.
Seek help for depression
Both MS and giving birth raise your risk of feeling depressed. If you feel “low,” or a loved one points out that you’re not acting like your usual self, talk to your doctor. The sooner you get support, the sooner you can feel better and enjoy your new baby.
