For many years, women with multiple sclerosis (MS) were advised not to become pregnant because of concerns about relapses after childbirth. But research now shows that pregnancy doesn't make MS worse, says Mary Ann Picone, MD, a board-certified neurologist and medical director at Holy Name Medical Center. “In fact, most women with MS often feel better during pregnancy.”
How Pregnancy Affects MS Symptoms
On average, women with MS have very few relapses during pregnancy. Your chance of having a relapse becomes lower as your pregnancy advances. A study that tracked 227 women before, during, and after pregnancy found a decline in relapse rates during pregnancy, with the biggest drop in the third trimester. Another study of 466 women from California also found significantly lower relapse rates during pregnancy than in the two years before conception.
Although relapses are less common during pregnancy, some symptoms can worsen. This is usually caused by normal pregnancy changes, but it can be difficult to tell them apart from MS symptoms.
“Patients can experience an increase in fatigue, most commonly in the first trimester,” Picone says. You may also become more sensitive to heat and have trouble sleeping, both of which can make fatigue worse.
You may need to go to the bathroom more often or feel more urgency to pee, especially as your baby grows and puts pressure on your bladder, Picone says. Urinary tract infections can also happen more often during pregnancy, and these can make MS symptoms feel worse.
Walking and moving around may become harder in late pregnancy because of the extra weight you are carrying and changes in your posture.
It’s important to remember that every woman’s experience of pregnancy with MS is different. You should talk to your midwife, doctor, or MS nurse if any of your symptoms get worse or if you experience new ones.
Why Is There a Reduced Relapse Rate During Pregnancy?
Doctors believe the lower relapse rate during pregnancy is linked to changes in hormones and the immune system. With MS, your immune system is overactive and causes inflammation in your brain and spinal cord.
During pregnancy, hormone levels, including estrogen and progesterone, rise. These hormones naturally calm your immune system so it doesn’t attack your growing baby. This decline in immune activity also helps lower MS-related inflammation.
“The hormonal changes that occur during pregnancy, particularly the increase in estriol during the third trimester, can help decrease central nervous system inflammation,” Picone says.
How Can I Manage MS Symptoms While Pregnant?
If you’re thinking about starting a family, it’s best to speak with your neurologist or MS nurse about your treatment options. “Certain disease-modifying therapies need to be stopped for a period of time — sometimes months — prior to conception,” Picone says. “Others, depending on how active a patient's disease is, can be continued during pregnancy.” Decisions are usually made on a case-by-case basis, based on how active your MS is and your personal preferences.
Some medications aren’t safe to take while you’re trying to get pregnant or during pregnancy. For example, B-cell depleting therapies, such as ocrelizumab (Ocrevus), ofatumumab (Kesimpta), and ublituximab (Briumvi), should be stopped about six months before trying to conceive, says Picone. Teriflunomide (Aubagio) should also be stopped six months before conception for both men and women. You can take ponesimod (Ponvory) until about a week before trying to conceive, while ozanimod (Zeposia) should be stopped at least two months before conception to allow the drug to leave your body.
Injectable interferon therapies such as Avonex, Betaseron, Extavia, Plegridy, and Rebif are generally safe to continue until pregnancy.
Glatiramer acetate (Copaxone) is considered safe to use both before and during pregnancy, Picone says. The same applies to Glatopa, the generic version of Copaxone, which contains the same active ingredient, works the same way, and is less expensive.
Another drug that you might keep taking while pregnant, if needed, is the infusion therapy natalizumab (Tysabri).
If you need to change your MS therapy during pregnancy and are worried about the cost, it’s good to know that all FDA-approved therapies are covered by insurance, and there are many copay assistance programs available, Picone says.
Can C-Sections or Anesthesia Trigger Relapses?
In the past, doctors worried that anesthetics might irritate damaged nerves and increase the rate of relapses. But research has shown that isn’t the case.
An Italian study that followed over 400 pregnancies found no link between C-sections or epidurals and more relapses or worsening disability.
A more recent Czech study confirmed the same results — the type of delivery (C-section or vaginal) and the choice of pain management didn’t affect MS activity in the months after birth.
So if you’re planning your delivery, you can feel reassured that choosing an epidural, spinal block, or C-section won’t make your MS worse.
What Can I Expect After Giving Birth?
After your baby is born, research shows that the risk of having a relapse is higher than it is during pregnancy, especially in the first few months.
In one study of 227 women, relapses were about one and a half times more common in the first three months after birth compared to the year before pregnancy. Even so, 72% of women in the study didn't have a relapse during that time. The relapse rate stayed slightly higher for up to nine months after birth, but then returned to prepregnancy levels. Another study found that relapse rates didn’t increase in the first three months but went back to prepregnancy levels by four to six months postpartum.
“The more stable a patient was before pregnancy, the less likely they are to be at risk for a relapse postpartum,” Picone says. “And the reverse of that is also true. The more aggressive someone’s disease was before pregnancy, the greater risk of having a relapse post-partum.”
Also, there is an increased risk of postnatal depression in both new mothers and new fathers with MS. So, emotional support and open conversations with your health care team are especially important during this time.
Why is there a higher risk of relapse immediately after pregnancy?
The hormonal changes that calm down your immune system during pregnancy offer a temporary break from MS symptoms but aren’t a cure. After you give birth, your estrogen levels drop suddenly, and your immune system becomes more active again. This makes MS relapses more likely in the first few months after birth, although not all women have a postpartum relapse.
How can I prepare for postpartum relapse?
To lessen the impact of a relapse after birth, it’s important to plan ahead, Picone says. Make a plan with your neurologist to monitor your MS closely after delivery and to restart your medication as soon as possible.
It also helps to schedule appointments in advance, Picone says. “We encourage patients to set up follow-up appointments for doctor’s visits, MRI exams, and other laboratory testing needed because it will be more difficult to remember to do these when also trying to balance the demands of caring for a newborn.”
Before your baby arrives, line up support to help you rest and manage newborn care. Talk to friends, family members, or anyone in your support network who can help with meals, errands, or childcare. If you don’t have family nearby, reach out to local resources such as social workers, hospital-based postpartum support programs, or community organizations that offer help to new parents.
Does Breastfeeding Affect MS Symptoms?
Most studies show that breastfeeding does not increase the risk of relapse or MS symptoms, Picone says.
One study found that breastfeeding exclusively for at least the first two months after birth may help lower the risk of having a relapse during the postpartum period.
However, breastfeeding isn't as protective as taking an MS medication.
If you choose to breastfeed, it’s important to know that some MS medications aren't safe to take while breastfeeding, but others can be used safely, Picone says. For example, interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaferon, Extavia), interferon beta-1a (Rebif), peginterferon beta-1a (Plegridy), and glatiramer acetate (Copaxone) are considered safe for moms who are breastfeeding.
It’s a good idea to talk with your health care team about breastfeeding and when to restart your treatment while you’re still pregnant. That way, you can have a clear plan in place before your baby arrives.
Does Pregnancy Affect Long-Term MS Outcomes?
There hasn’t been a lot of research on how having a baby affects MS in the long run. But the studies that do exist suggest that having a baby doesn’t change the overall course of MS or your chances of developing secondary progressive MS.
Some research suggests that pregnancy and childbirth might actually be linked to less disability over time. For example, a Belgian study followed 330 women for 18 years and found that women who had given birth (either before or after getting MS) were 34% less likely to reach the point where they needed a walking aid.
Takeaways
During pregnancy, you’ll likely have fewer MS relapses, especially in the third trimester. This happens due to hormonal changes that calm your immune system. You might notice some symptoms, such as fatigue and bladder issues, getting worse because of normal pregnancy changes. After your baby is born, your relapse risk may temporarily go up. So, it’s important to plan ahead with your neurologist and get support in place. Overall, having a baby doesn’t change the long-term course of MS.
