Multiple Sclerosis and Pregnancy

Multiple sclerosis (MS) is a
chronic disease of the central nervous system, which is made up of the brain and spinal
cord. MS is unpredictable. It can range from benign to disabling. Some people with MS
may be mildly affected. Others may lose the ability to write, speak, or walk.


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Many things may cause MS, including
viruses, autoimmune disorders, environmental factors, and genetic factors. But all of
the possible causes share a common feature. The body’s immune system attacks its own
nervous tissue. In MS, the immune system attacks the layer of protein called myelin that
surrounds the nerve fibers in the central nervous system. Myelin insulates the
electrical signals the nervous system uses to communicate. When this insulation is
destroyed, communication is interrupted. Parts of the nervous system become permanently
damaged.


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Symptoms of MS are erratic. They
may be mild or severe. They may last a short or long time. They may appear in various
combinations, depending on the part of the nervous system affected. Throughout the
course of the illness, you may have any or all of these symptoms:

  • Muscle weakness in the arms and legs
  • Trouble with coordination
  • Impaired walking or standing
  • Partial or complete paralysis
  • Spasticity (involuntary increased tone of muscles leading to stiffness and spasms)
  • Fatigue (may be triggered by physical activity, may ease with rest, or may be constant and persistent)
  • Loss of sensation, tingling or numbness
  • Speech problems
  • Tremor
  • Dizziness
  • Hearing loss
  • Loss of vision or changes in vision
  • Loss of bowel and bladder control
  • Sexual dysfunction
  • Pain
  • Emotional changes
  • Changes in reflexes

MS may also cause cognitive
effects. The effects may be mild. They are often found only after thorough testing. They
may include problems with:

  • Concentration
  • Attention
  • Memory
  • Judgment

The symptoms of MS may look like
other health problems. Always see your healthcare provider for a diagnosis.

Your healthcare provider will do a
thorough medical history and a physical exam as the first steps toward diagnosis of MS.
You will be asked about all of your symptoms, how often they occur and how long they
last.

You will likely have an MRI
(magnetic resonance imaging) scan. This test can detect the unique scars in the central
nervous system.

In some cases, you may need lab tests or a lumbar puncture to confirm the diagnosis.

There is no cure for MS. But there are disease-modifying therapies
available that can slow the progression of the disease and improve symptoms. These
include:

  • Beta-interferons
  • Glatiramer acetate
  • Monoclonal antibodies
  • Dimethyl fumarate
  • Fingolimod
  • Teriflunomide

There are also treatments to help manage symptoms, treat flare-ups or
relapses, improve your function and safety, and provide much needed emotional support.
The following

rehabilitation therapies may also help:

  • Physical therapy
  • Occupational therapy
  • Speech and swallowing assistance
  • Cognitive therapy
  • Assistive devices like splints

Fortunately, pregnancy does not
appear to speed up the course or worsen the effects of MS. Several studies suggest that
MS is less likely to flare up late in pregnancy. But there is a slightly higher risk
right after pregnancy.


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The disabling effects of the
disease may make it physically hard to carry a pregnancy. Muscle weakness and
coordination problems may increase the likelihood for falls. Fatigue may worsen.
Wheelchair dependence may increase the risk for urinary tract infections. There is no
evidence that MS causes infertility. Studies have shown that pregnancy, delivery, and
rate of birth defects are not majorly different in women with MS compared with those
without MS. 

Many of the medicines used to treat
MS may have adverse effects on a fetus. It is important to talk with your healthcare
provider if you are thinking about pregnancy or if you become pregnant. Your healthcare
provider will discuss the risks and benefits of the various medicines with you,
including any possible effects on your baby and your MS.

During pregnancy, you will need
close monitoring to keep track of the disease and the health of the fetus. You may need
more frequent prenatal visits. There is no established treatment that alters the course
of MS. But you may be given medicines such as steroids and anti-inflammatory drugs.
Consult your healthcare provider for more information.

Supportive treatment and
rehabilitation for MS are especially important during pregnancy. Rehab varies depending
on your symptoms. But it may help with the following:

  • Doing normal activities of daily
    living (ADLs)
  • Maintaining independence
  • Getting family involved
  • Using assistive devices (for example,
    canes, braces, and walkers)
  • Setting an appropriate exercise
    program to promote muscle strength, endurance, and control
  • Re-establishing motor skills
  • Improving communication skills if you
    have trouble speaking because of weakness or lack of coordination of face and tongue
    muscles
  • Managing bowel or bladder
    incontinence
  • Providing cognitive retraining
  • Adapting the home environment for
    safety and usability

During labor, you may not have pelvic sensation, and you may not feel
pain with contractions. This may also make it hard to tell when labor starts. Delivery
of the baby may be harder if you have MS. While labor itself is not affected, MS can
affect the muscles and nerves needed for pushing. For this reason, you may need a
cesarean section or delivery with the help of forceps or vacuum.

Call your healthcare provider if
you have several of the classic symptoms of MS so that treatment can begin right away.

If you have MS and want to get
pregnant, discuss the benefits and risks of a pregnancy with your MS specialist before
becoming pregnant.

If you are pregnant and have MS,
tell your healthcare provider as soon as possible.

  • There is no cure for MS. But there are
    many ways to help slow the progression of the disease and manage symptoms.
  • With MS, you may have long periods of remission of your symptoms.
  • Pregnancy is not ruled out just because you have MS. Pregnancy doesn’t seem to speed up or worsen MS.
  • MS can make carrying a pregnancy
    harder. It may also make labor and delivery more difficult.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.