Plans for pregnancy must be considered when choosing between various disease modifying therapy (DMT) types.1MS symptoms should ideally be adequately controlled2and disease activity stable for at least 6-12 months prior to conception.3Women with MS who are planning to become pregnant are advised to take prenatal vitamins, including folic acid and vitamin D.4
What are the treatment options for multiple sclerosis (MS) during pregnancy?
Many women with MS do not require DMTs during pregnancy, although injectables could be continued. For women with highly active MS, cell-depleting therapies could be given before conception, or natalizumab could be continued through pregnancy, with monitoring of the fetus.
Is it safe to have MS during pregnancy?
Some of your MS symptoms may feel worse during pregnancy, like fatigue or bladder symptoms. If you have balance or mobility problems, they might feel worse toward the end of your pregnancy with the additional weight of the baby. Most medications that are used to treat MS symptoms are not safe to use during pregnancy.
Can you take prednisone while pregnant with MS?
Use of corticosteroid medications. Women who use corticosteroids (for example, methylprednisolone or prednisone) for acute MS relapsess may continue to use them during pregnancy. The use of prednisone in a woman who is breastfeeding should be carefully monitored.
Are there fewer MS relapses during pregnancy?
There are fewer MS relapses during pregnancy, especially in the second and third trimesters. Changes that take place in a woman’s body during pregnancy are believed to contribute to less inflammation, less MS activity and fewer relapses.
Does MS medication affect pregnancy?
Most medications that are used to treat MS symptoms are not safe to use during pregnancy. Work with your MS healthcare provider to determine if, when and how you should stop any medications you are taking. Women with MS usually need no special gynecologic care during pregnancy.
Does MS treatment affect fertility?
In general, MS does not impact fertility.
Can you conceive if you have MS?
Recent research can answer some of them. Generally, the answer is yes, it's safe to become pregnant if you have MS. In fact, a 2016 study states that MS is more common in women of childbearing age than in any other demographic. Medical management and a supportive team will be key to a successful pregnancy.
Are you high risk pregnancy if you have MS?
WEDNESDAY, Feb. 3, 2021 (HealthDay News) -- In a finding that should reassure women with multiple sclerosis (MS) who want to have a baby, new research suggests the disease doesn't raise the risk of pregnancy complications.
Can I do IVF if I have MS?
In conclusion, MS patients who are stable and without a recent relapse can still safely consider IVF, but those with more active disease should achieve disease stabilization before proceeding.
Can MS affect reproductive system?
Effect on the reproductive system MS can directly affect the reproductive system in several ways, including: damaging the nervous system, affecting a person's sexual sensations. reducing the ability to orgasm or ejaculate because of neuron damage. creating difficulty getting an erection or becoming lubricated.
What are the symptoms of MS?
What are the symptoms of multiple sclerosis? Symptoms of MS are erratic. They may be mild or severe, and of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected.
What causes MS?
Many things may cause MS, including viruses, autoimmune disorders, environmental factors, and genetic factors. But, all of the possible causes share the common feature that 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 ...
What is the immune system's response to MS?
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.
Can you get pregnant with MS?
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 having the symptoms of MS, tell your doctor as soon as possible. If you have MS and you are pregnant, let you doctor know as soon as possible.
Is pregnancy a cure for MS?
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.
Can MS cause fatigue during pregnancy?
Muscle weakness and coordination problems may increase the likelihood for falls. Fatigue may worsen.
Is MS a chronic disease?
MS is a chronic disease of the central nervous system, which is made up of the brain and spinal cord. MS is unpredictable and can range from benign to disabling. Some people with MS may be mildly affected. Others may lose the ability to write, speak, or walk.
What is a pregnancy registry?
Pregnancy Registries. Pregnancy Registries for the MS Disease-Modifying Medications. The manufacturers of the FDA-approved disease-modifying medications establish pregnancy registries to monitor pregnancy outcomes in women who take one of these drugs within a week of becoming pregnant or while they are pregnant.
Can MS patients have gynecologic care?
Women with MS usually need no special gynecologic care during pregnancy. Labor and delivery are usually the same as in other women and no special management is needed. All forms of anesthesia are considered safe and well tolerated for women during labor and delivery.
Does MS cause pregnancy?
There is no evidence that MS leads to an increased number of spontaneous abortions (miscarriage), stillbirths or congenital malformations. Several studies of large numbers of women have repeatedly demonstrated that pregnancy, labor, delivery and the incidence of fetal complications are no different in women who have MS than in women who do not have MS.#N#There are fewer MS relapses during pregnancy, especially in the second and third trimesters. Changes that take place in a woman’s body during pregnancy are believed to contribute to less inflammation, less MS activity and fewer relapses.#N#If you experience a relapse during pregnancy, treatment with corticosteroids (for example, methylprednisolone or prednisone) may be considered. Corticosteroids are believed to be safe in the second and third trimester but are not considered safe during the first trimester.#N#Some of your MS symptoms may feel worse during pregnancy, like fatigue or bladder symptoms. If you have balance or mobility problems, they might feel worse toward the end of your pregnancy with the additional weight of the baby.#N#Most medications that are used to treat MS symptoms are not safe to use during pregnancy. Work with your MS healthcare provider to determine if, when and how you should stop any medications you are taking.#N#Women with MS usually need no special gynecologic care during pregnancy. Labor and delivery are usually the same as in other women and no special management is needed. All forms of anesthesia are considered safe and well tolerated for women during labor and delivery.#N#Depending on your specific symptoms, there are modifications, like specific positions or the use of medications, that can make your birthing experience more comfortable. Discuss your MS symptoms and birth plan with both your MS healthcare provider and maternity care provider.
Is interferon-beta safe for pregnancy?
Some studies have demonstrated that interferon-beta and glatiramer acetate are safe to be taken up until conception and during pregnancy ( Vukusic and Marignier, 2015 ). For women taking fingolimod or natalizumab, there may be a risk of “rebound’ disease activity after stopping the medication for pregnancy ( Langer-Gould, 2019 ).
Does MS affect conception?
Fertility and conception with MS. There is no evidence that MS impairs fertility. Studies have shown that some types of fertility treatment may increase the risk of relapses in women with MS, with relapse rates increasing in the three months after in vitro fertilization.
Can MS make you feel worse while pregnant?
Some of your MS symptoms may feel worse during pregnancy, like fatigue or bladder symptoms. If you have balance or mobility problems, they might feel worse toward the end of your pregnancy with the additional weight of the baby. Most medications that are used to treat MS symptoms are not safe to use during pregnancy.
Is depression a symptom of MS?
Depression is a common symptom of MS and some studies suggest that post-partum depression is more common in parents with MS. Talk to your MS healthcare provider or your maternity provider if you notice changes in your mood during pregnancy or after delivery.
Is MS a treatable disease?
As MS became a treatable disease, management of DMTs before, during and after pregnancy is important. This requires updated knowledge on safety of DMTs as well as data of the effect on disease activity after drug withdrawal. A special challenge is the handling of women with highly active MS, as pregnancy might not be powerful enough to suppress ...
Can MS be treated early?
Women with multiple sclerosis (MS) are treated early in the disease course with disease modifying therapies (DMT). Updated information is needed on pregnancy outcomes of DMT-exposed pregnancies and the effect of the drug withdrawal on MS disease activity. Areas covered: In this review, we will cover the most important updated management strategies in planning a pregnancy when having MS. Expert opinion: MS itself does not increase the risk of adverse pregnancy outcomes and does not negatively influence the long-term course of the disease. As MS became a treatable disease, management of DMTs before, during and after pregnancy is important. This requires updated knowledge on safety of DMTs as well as data of the effect on disease activity after drug withdrawal. A special challenge is the handling of women with highly active MS, as pregnancy might not be powerful enough to suppress the risk of rebound relapses. Exclusive breastfeeding is an option for many women who want to do so, but in cases of high disease activity and those women who do not want to breastfeed, early reintroduction of MS therapies should be considered.
When discussing treatment of MS in women of reproductive age, counseling should include discussion of DMT safety before and during pregnancy?
When discussing treatment of MS in women of reproductive age, counseling should include discussion of DMT safety before and during pregnancy. Since relapses typically decrease during pregnancy, most women are able to safely discontinue treatment for pregnancy. Relapse risk is highest in the first trimester of pregnancy, which should be considered when timing DMT discontinuation. Women with more active MS or on DMTs with risk of disease reactivation upon discontinuation should carefully plan treatment before pregnancy to decrease relapse risk.
What is the management of MS?
The management of women with MS of childbearing potential thus requires a plan covering pregnancy planning, pregnancy, and the postpartum period. Disease activity, impact of therapy withdrawal, and effects of MS therapy on the fetus, together with any plan for breastfeeding, should all be considered.
What should be considered when planning for pregnancy?
Pregnancy planning should consider maternal disease activity, risk of disease reactivation with therapy withdrawal, postpartum relapse risk, and breastfeeding plans. Breastfeeding may be protective against postpartum relapses; however, in women with active disease, concomitant use of certain DMTs should be considered.
What are the factors that influence the transfer of drugs to breastmilk?
Generally, several factors influence drug transfer to breastmilk, such as molecular weight, lipid solubility, protein binding, volume of distribution, transport mechanisms, and breastmilk stage (more transfer to colostrum than mature milk) [ 58 ]. Other factors to consider include oral bioavailability of a drug in an infant if it enters the breastmilk and potential toxicity of a particular drug to the infant. Despite theoretical understanding of drug transfer based on drug properties and animal lactation studies, human studies are necessary to evaluate drug transfer to breastmilk in treated women. The relative infant dose (RID) is a measure of drug breastmilk transfer and is the percentage of maternal dose consumed through breastmilk in 24 h ( [breastmilk drug concentration (mg/L)*0.15 L/kg/day*maternal weight (kg)]/maternal dose (mg)). RID values of less than 10% are generally acceptable for breastfeeding, although toxicity of the drug also influences safety while breastfeeding [ 59 ].
When is MS diagnosed?
MS is typically diagnosed between the ages of 20 and 40, and more commonly in women than men. The sex ratio in RRMS has been steadily rising since the 1950s and is about 3:1 [ 2, 3 ]. Therefore, the burden of early disease is disproportionately weighted towards women of childbearing age.
Can MS affect pregnancy?
Many women with MS report improved symptoms during pregnancy. However, pregnancy can impact specific functional domains such as cardiovascular conditioning, spasticity, and mood. Since these have not been rigorously evaluated in MS, there are limited data to guide care, and therefore we describe our combined clinical experience. As a general principle, monitoring may include comprehensively evaluating and treating the following functions and when warranted multidisciplinary referrals (e.g., psychologist, psychiatrist, physical therapist, pelvic floor therapist, and/or urologist).
Can IgG1 be injected into breast milk?
Further, even if ingested in milk, they have limited oral bioavailability. Although some undigested IgG molecules enter the neonatal circulation through the neonatal Fc receptor in rodents, this oral absorption appears to be much lower in humans [ 64 ]. To date, studies have not noted negative effects on infant health of those breastfeeding from mothers treated with mAbs [ 63 •, 65 ]. IgG1 monoclonal antibodies used for MS include alemtuzumab, ocrelizumab, and rituximab. There is low breastmilk transfer of rituximab with median RID 0.08% (range 0.06–0.10%), suggesting this is compatible with breastfeeding [ 66 ••]. Further, normal B-cell counts have been reported in 5 infants who received rituximab or ocrelizumab while breastfeeding [ 40 ••]. Studies of breastmilk transfer are needed for alemtuzumab and ocrelizumab, although it is expected that transfer would be similarly low, and that infused IgG1 molecules would not enter the neonatal circulation in biologically relevant amounts. Natalizumab, an IgG4 molecule, might have greater transfer into breastmilk, with an estimated RID of up to 5.3% [ 67 ]. Although there is theoretical concern for cumulative effects with monthly dosing, a recent study found no evidence of natalizumab accumulation in breastmilk after up to 4 infusions, and no anemia or other adverse outcomes in 2 infants exposed only through breastmilk [ 40 ••]. One infant with third trimester natalizumab exposure had detectable natalizumab in the serum at birth, but no detectable natalizumab later while breastfeeding despite ongoing maternal natalizumab treatment [ 40 ••]. This suggests that the breastfeeding infant does not significantly absorb natalizumab.
MS and Pregnancy: Progression
While pregnancy rates in the United States have been declining since 1990, pregnancy in women with MS has actually increased. This may be due to a greater understanding of the effects of pregnancy for women with MS. 3
Before Pregnancy
The diagnosis of MS often occurs between the ages of 20 to 40, during prime childbearing years when women may consider starting a family. 3
During Pregnancy
Pregnancy leads to many changes to a woman’s body. For a woman with MS, pregnancy may actually help with relapses. 7
After Pregnancy
Bringing home a baby is an exciting time for most mothers. However, for mothers with MS, there are some additional issues to consider when breastfeeding and resuming medications.
A Word From Verywell
A safe pregnancy is possible for women with MS, though it will take a little more planning and consideration. Managing your disease will be challenging during this period. Make sure you discuss the potential risks and changes to your treatment plan with your physician before you plan to conceive.