You have multiple sclerosis and you want to have a baby. Not a problem, experts say, but be sure to talk to your doctor about coming off medications and other pregnancy preparations.
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MS doesn’t appear to affect fertility in any significant way, says neurologist Mary R. Rensel, MD. Women with multiple sclerosis have a normal fertility rate and no increase in fetal abnormalities or spontaneous miscarriage.
“It doesn’t change the course of pregnancy, either,” Dr. Rensel says. A woman with MS is just as likely to carry a child to full term as someone without the disease.
In fact, pregnancy just might be one of the best things that can happen to an MS patient. A shift in the immune system — to the same immunosuppressants that tell the body not to attack the baby — and the change in hormones often cause the illness to go into remission.
“Typically, during pregnancy women with MS feel good,” Dr. Rensel says. “It’s a pretty protected time.”
Researchers are even looking into using estradiol — a form of estrogen which is at high levels during the last trimester of pregnancy — as a treatment for MS.
That’s a good thing, because many doctors recommend doing without MS medications when you’re pregnant.
Making the right medication choices
Dion W. of Northeast Ohio, who has MS, stopped taking her medications when she found out she was pregnant. “I was told I don’t need them at this time,” she says. She plans to deliver at Hillcrest Hospital in June.
Dion was on Copaxone — a category “B” drug considered relatively safe for pregnant moms — at the time she got pregnant, Dr. Rensel says. However, because little research exists involving most MS-modifying drugs and pregnancy, she tells patients to stop taking them.
Dion has been off of medication for months now, and says her MS has not been a problem. She feels “big and tired,” like most women do along the way during pregnancy, but says it’s not the same type of fatigue that she experiences with MS.
Dr. Rensel notes that a new MS drug on the market — Aubagio — has an “X” rating and carries a severe risk of malformation. “We just have to have a conversation … to know what medications they’re on and which are safe to continue,” she says. “Anything beyond B we don’t recommend they continue during pregnancy.”
Women who are planning a pregnancy should stop most medications at least a month in advance. Some medications require more time off. For information about a particular drug, Dr. Rensel steers patients to a pregnancy registry for MS medications on the National Multiple Sclerosis Society website.
But don’t panic if you have an unplanned pregnancy while on MS medication, she says. “Work with your neurologist and your OB. They just need to get information to make a long-term plan.”
Planning for baby
Along with considering medication changes, prospective moms with MS must be alert to relapses. “If any new symptom lasts more than two days, give your neurologist a call,” Dr. Rensel says.
There are times when she advises women to postpone pregnancy. “It depends how active their MS is. If it looks like a more aggressive MS situation, I may recommend treating for a year or two before getting pregnant,” Dr. Rensel says.
For those who get the green light, she suggests they work on general wellness habits just like any mother-to-be, including:
- Eating a healthy diet
- Getting plenty of exercise
- Taking folic acid
- Maintaining a healthy weight
- Using a Vitamin D supplement and/or prenatal vitamin
“Like anyone getting pregnant, we stress all those, because they affect the health of the mom and the baby,” Dr. Rensel says.