June 20, 2024

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most important health challenges

Safety, Concerns, Medications, and More

People with multiple sclerosis (MS) can become pregnant and carry a baby to full term. They may have to discuss some medication changes with a doctor.

Pregnancy may pose challenges for people with MS. Some medications may not be safe for use during pregnancy, and some people may experience a relapse of MS symptoms during the postpartum period.

Read on to learn about the ways MS can affect fertility, pregnancy, and the postpartum period.

Generally, the answer is yes: It’s safe to become pregnant if you have MS.

MS is more common in women of childbearing age than in other demographics. Medical management and a supportive team can help you have a successful pregnancy with MS.

Multiple studies show that the following are generally no different regardless of whether someone has MS:

A 2019 study found that women with MS had a moderately increased risk of infections and a risk of preterm delivery that was 20–30% higher than in women without MS. However, the researchers also concluded that there was no increased risk of the following complications:

  • difference in fetal growth
  • preeclampsia
  • chorioamnionitis, a type of bacterial infection of the placenta
  • stillbirth
  • postpartum hemorrhage
  • major birth abnormalities

It’s not clear how the risk of pregnancy complications might change based on the severity of a person’s MS, and scientists have identified this as a gap in research.

A 2022 review of research reported that those with MS were more likely to have Cesarean delivery, assisted vaginal delivery, and induced labor. There might be factors besides MS that contribute to this, including an increased rate of respiratory and bladder infections.

Furthermore, research shows that MS flare-ups tend to decreaseduring pregnancy — especially in the latter two-thirds of pregnancy.

MS does not appear to affect fertility.

If a person with MS wants to become pregnant, they should discuss it with a doctor. Doctors may recommend changes to a person’s medication, as some medications may carry risks for pregnant people and their babies.

Doctors may also recommend waiting until the disease is stable for one year before becoming pregnant. Research from 2022 suggests that having a relapse in the year prior to pregnancy may increase the risk of worsening long-term disability.

A 2021 review of research notes that pregnancy appears to be associated with a decreased risk of relapse.

Research shows that the overall risk of fetal complications during pregnancy is no different for those with MS than it is for those without MS.

A 2019 study found that women with MS were more likely to have preterm births, but there’s no evidence that having MS increases your risk of Cesarean delivery or congenital differences.

Depending on your symptoms, a doctor might recommend specific medications or birthing positions that can make your delivery experience more comfortable. However, people with MS generally don’t require special care during pregnancy and childbirth.

But bladder, bowel, fatigue, and gait issues — common among all pregnant people — may be worse for people with MS who already experience those issues.

MS medications and pregnancy

Medications for MS treat acute attacks, lessen symptoms, and slow the progress of the disease itself.

Medications for the first two purposes are usually safe to continue during pregnancy. If you take a disease-modifying agent, your doctor will advise you when to stop taking it — usually before you try to conceive.

Stopping some medications, such as natalizumab (Tysabri), may increase your risk of relapse. It’s important to talk with your doctor and weigh the risks and benefits of stopping medications before trying to get pregnant.

Research is limited on whether certain medications are safe during pregnancy. Doctors typically recommend using them only if the possible benefits outweigh the risks. Some of the common practices and recommendations include:

  • glatiramer acetate (Copaxone), which may be continued during pregnancy in some situations
  • interferon preparations, which may be continued in selected patients, such as:
    • interferon beta-1a (Avonex, Rebif)
    • interferon beta-1b (Betaseron, Extavia)
    • peginterferon beta-1a (Plegridy)
  • natalizumab (Tysabri), which may be continued until 34 weeks of pregnancy in some situations

MS medications that aren’t recommended if you’re pregnant include:

  • alemtuzumab (Lemtrada)
  • cladribine (Mavenclad)
  • fingolimod (Gilenya)
  • ocrelizumab (Ocrevus)
  • teriflunomide (Aubagio)
  • dimethyl fumarate (Tecfidera)

Research suggests that having more prepregnancy MS relapses puts you at a higher risk for postpartum relapses.

Some studies have found an increased risk of relapse in the first 90 days after childbirth. Relapse rates may increase by anywhere from 11% to 25%. Note that the relapse rate of 11% was seen in a group that had continuous health insurance and prescription drug coverage, while the relapse rate of 25% was seen in studies where most participants had untreated MS.

A 2020 study suggests that exclusive breastfeeding may help reduce the risk of relapse in the postpartum period. While the study doesn’t prove or guarantee that breastfeeding will prevent relapse, it suggests that it isn’t harmful and could be beneficial for your health.

Many of the disease-modifying therapies used for MS are not recommended during breastfeeding. So your decision about breastfeeding may involve weighing pros and cons. It’s best to discuss this with your doctor as you make your decision.

MS-related disability and a higher relapse rate before or during pregnancy are also associated with more postpartum relapses, according to the 2020 study mentioned earlier. Despite this increased risk, most of the 67.2% of study participants whose MS wasn’t well-controlled prepregnancy did not have any relapses in their postpartum year.

Relapses in MS symptoms often resolve without substantial lasting disability, but many people experience some overall decline after each relapse. However, you should anticipate fatigue in the short term.

Plan to focus on parenting, resting, and taking care of your health for the first 6-9 months after delivery. This might include prioritizing:

  • nutrition
  • exercise
  • social support
  • physical or occupational therapy

You can arrange for help with household tasks and babysitting, if needed.

Some studies have found an increased risk of postpartum depression in people with MS, with those receiving an MS diagnosis during the postpartum period at an especially high risk.

MS medications and breastfeeding

Some MS medications cannot be taken safely if you are breastfeeding.

These can include:

  • alemtuzumab (Lemtrada)
  • cladribine (Mavenclad)
  • dimethyl fumarate (Tecfidera)
  • fingolimod (Gilenya)
  • ocrelizumab (Ocrevus)
  • teriflunomide (Aubagio)

People living with MS need to plan for ongoing support when considering pregnancy. This planning begins with finding a neurologist and an obstetrician who can guide you in safely expanding your family.

Managing MS and being pregnant are challenging enough individually, let alone together. You should choose doctors who will help you sort through your concerns, steer you toward appropriate resources, and encourage you through any challenges.

Once you have a supportive clinical care team, you can discuss specific concerns with them. Questions you may ask include:

How will pregnancy affect my fatigue levels?

Pregnancy typically causes fatigue, which can make MS-related fatigue worse. But, the level of fatigue that each person feels is different and may change over the course of pregnancy.

Can I take MS medications while pregnant and breastfeeding?

Some MS medications may be safe for use while pregnant and breastfeeding.

Many medications that treat attacks and reduce symptoms are safe for use during pregnancy, while disease-modifying therapies may need to be stopped before conception. For many medications, additional research is still needed.

What if my MS relapses?

While pregnancy is associated with a decreased risk of relapse, some people may experience relapses during pregnancy.

People may be more likely to experience relapses postpartum. If you experience a relapse during or after pregnancy, a doctor can recommend treatment that best fits your situation.

Can MS be transmitted to a baby?

While a person with a family history of MS may have an increased risk of developing it, MS cannot be directly passed from parent to child during pregnancy or breastfeeding.

Likely, multiple factors, including genetics and environment, influence whether a person develops MS.

Will I be able to get pregnant?

MS does not typically affect fertility. Many people with MS go on to become pregnant and deliver healthy babies.

Could pregnancy worsen my MS?

Pregnancy is often associated with a reduced risk of MS relapse.

But pregnant people typically experience bladder, bowel, fatigue, and gait issues. If you already experience those symptoms due to MS, they may get worse during pregnancy.

How does MS affect pregnancy?

While the risk of pregnancy complications is generally similar for people with and without MS, people who already experience symptoms with bladder and bowel control and issues with gait and fatigue may experience worsening of these symptoms in pregnancy. Some people may have to stop taking certain disease-modifying therapies during pregnancy, which may result in relapse.

Is pregnancy with MS high risk?

MS does not increase the risk of pregnancy complications and is not considered a high risk pregnancy.

Can you still have a healthy baby if you have MS?

Yes, many people with MS have healthy babies. MS does not affect your ability to carry a pregnancy to term.

MS is unpredictable, so you may feel life’s uncertainty acutely. However, when it comes to pregnancy and parenthood, everyone walks into unknown territory.

Support and rehabilitation after pregnancy are especially important for people living with MS. Actions you can take to help maintain independence and make the postpartum period more manageable include:

  • performing your normal daily activities
  • asking family and friends for help with child care
  • developing an exercise routine to promote strength
  • using assistive devices such as canes, braces, or walkers
  • working with your clinical team to manage incontinence and motor skills

You may wish to download the document Pregnancy, Delivery, and the Post Partum Period from the National Multiple Sclerosis Society to share with your doctors.

Additional helpful resources for MS include: