Managing Multiple
Sclerosis (MS) in Pregnancy
How common is this situation- pregnancy in women with
MS?
MS is most often
diagnosed between the ages of 20 to 40 years. This is the age when most women
plan their pregnancies. Therefore, it is very common to find women with MS, who
are pregnant or those who are planning pregnancy.
Which is a better option- starting MS treatment and
then planning pregnancy or delaying MS treatments until after completing
family?
MS is characterized
by multiple relapses (when new symptoms occur). With each relapse, the
disability increases. These relapses are often more frequent in the initial
years after diagnosis of MS. Disease modifying drugs (DMD) can reduce relapses
and disability. Therefore, it is always better to start DMD and then plan
pregnancy. One should not postpone starting DMD after pregnancy/delivery.
How does pregnancy affect MS?
Pregnancy does not
affect MS in the first trimester.
The MS relapses
are lesser in 2nd and 3rd trimesters, which is good news.
However, the
relapses become more frequent in the post partum period (after delivery) and this
higher risk persists until 6 months after delivery.
How does MS affect pregnancy?
By and large,
there are no adverse effects of MS on pregnancy. Women with MS have no extra
risk of miscarriage or birth defects in their babies; as compared to women without
MS. The mode of delivery too need not be altered just because the patient has
MS.
MS has no direct
effect on fertility. Women with MS may have sexual dysfunction resulting in lesser
libido. Male partners who have MS may suffer from erectile dysfunction.
What MS medications are safe in pregnancy?
No DMD has yet
been tested in pregnancy and hence none can be declared safe. However, recent
evidence suggests that some DMDs are less risky than others. Less risky DMDs in
pregnant women with MS include beta interferons (Avonex, Rebif, Betaseron) and
Glatiramer acetate.
For prospective
fathers, beta interferon and Glatiramer acetate as DMD showed no risk to baby’s
health. Teriflunomide is detected in semen and it should be discontinued before
trying to conceive.
Steroids can be safely used to treat MS relapses during
pregnancy.
Will babies born to women with MS have a higher risk
of getting MS themselves?
Most cases of MS
are sporadic and most women with MS do not have a history of MS in their family
members. However, having a relative with MS does slightly increase the risk of
being diagnosed with MS.
In UK, the
lifetime risk of being diagnosed with MS in general population in 1 in 330. The
risk increases to 1 in 48, if one of the first degree relatives has MS. If one
of the second-degree relatives has MS, the risk of being diagnosed with MS is 1
in 100.
an women with MS breastfeed?
Breastfeeding is
safe and can be continued as usual.
What impact does pregnancy have on the course of MS?
There is limited
data on this topic. However, in one study, pregnancy and childbirth were
associated with lesser chances of developing severe disability. Women who gave
birth at any time (either before or after the onset of MS) were 34% less likely
to develop severe disability (as defined by need to use walking aid).
(For more reading, Multiple sclerosis Trust, UK)
Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
