MS May Flare Up Postpartum, but Nothing You Can’t Handle

Relapse risk higher after birth, but new mom carries on

Dion W. of Northeast Ohio lost her balance, gained an unstable gait and experienced extreme fatigue about two weeks after she delivered her first baby.

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“I thought it was just because of the childbirth,” she says.

Her doctors quickly determined that it was her multiple sclerosis rearing its ugly head again. Dion was first diagnosed with MS about 15 years ago.

She was able to forgo medication during her pregnancy, thanks to nature’s immunosuppressants working on the baby’s behalf. But now her body’s immune system has returned to its pre-pregnancy state.

Neurologist Lael Stone, MD, promptly placed her on corticosteroids, since she wasn’t breast-feeding.

Moms with MS who breastfeed — believed to sometimes stave off symptoms — usually don’t restart medication for the disease until the weaning process, Dr. Stone says.

Playing catch-up

Although relapse rates tend to rise in the first few months postpartum — up to a 40 percent chance, according to the National Multiple Sclerosis Society — it shouldn’t be dreaded, Dr. Stone says.

“We get a lot of people very concerned because they think they’re definitely going to have a relapse postpartum,” she says. She added that some patients wrongly assume they should avoid pregnancy altogether. “When you look at all the data, it’s relatively rare.”

Such flare-ups often are referred to as “catch-up” relapses, because “it’s the relapse you would have probably had during that nine-month period if you hadn’t been pregnant,” Dr. Stone says.

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Knowing the triggers

There are potential factors, besides crashing hormones, that can exacerbate the situation, including sleep-deprivation or infection.

“Any sort of infection will trigger a relapse,” Dr. Stone says. “Most common is urinary tract infections. Patients with MS may not have the usual symptoms of frequency and burning, so you have to know to look for it.”

A UTI can affect one’s walking, leading some patients to believe that they are having an MS attack.

“It might be what we call a pseudo relapse,” Dr. Stone says. “Anytime they get a fever or over-tired, they may get temporarily worse, but it’s not a true relapse; they don’t need steroids, they need antibiotics.”

So how do you know the difference? Dr. Stone says to watch for these symptoms:

  • Difficulty walking
  • Difficulty talking
  • Vision impairment
  • Loss of hand function

“If your left toe is a little tingly, we’re probably not going to give you steroids,” she says.

Adjusting to the new normal

Typical recovery for a relapse is a month to six weeks, Dr. Stone says.

Most patients bounce back nicely, if they are generally healthy to begin with, she says, pointing to Dion as a prime example. “Things are definitely settling down for her. I think she’s a very resilient person emotionally and physically.”

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While the relapse slightly delayed Dion’s return to full-time work in her human resources job, she agrees that she is otherwise improving.

Now she deals mostly with “normal” new-mom problems, like trying to fit into her old clothes.

“I look at my wardrobe like, oh I miss you,” she says. “You are such a cute sweater.”


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