DEAR DOCTOR K:
I have multiple sclerosis. My husband and I would like to have a baby. What do I need to know before I get pregnant?
Multiple sclerosis (MS) is a disease that affects communication between nerve cells in the brain and spinal cord and the rest of the body. This results in symptoms that may include fatigue, weakness, pain and trouble with movement. In the most common form of the disease, sudden worsening of symptoms (flare-ups or relapses) alternate with symptom-free periods (remissions).
Women get MS considerably more often than men. In addition, MS in women often begins in their 20s or 30s — just the time when many women are thinking about starting a family.
Fortunately, getting pregnant does not seem to affect the risk of developing MS. But you already have MS, so the question you need answered is whether getting pregnant will have any adverse effects on you or your baby.
The good news is that pregnancy and childbirth do not have any negative long-term effects on women with MS, or on their babies. There are, however, issues you need to consider if you’re thinking about becoming pregnant.
It’s important to address your medications. Your doctor may recommend stopping your medications before and during your pregnancy, as MS drugs may not be safe for your baby. Talk to your doctor before you start trying to get pregnant. He or she can tell you how long it will take for the drugs to leave your system, and when it will be safe for you to become pregnant.
Will being pregnant affect your MS? Pregnancy itself seems to protect against disease flare-ups. But it can make women with MS more susceptible to various symptoms and conditions, including fatigue, constipation and urinary tract infections.
The first six months after you’ve given birth, on the other hand, are the highest-risk period for disease flare-ups. During this time, you’ll want to take as good care of yourself as possible to reduce the risk of a relapse. That means getting enough rest and trying to avoid infections, fevers, stress and anemia.
If your baby doesn’t sleep through the night, that’s easier said than done. If at all possible, I’d strongly recommend asking family members for support or hire additional help during the weeks or months after delivery. But if your symptoms do get worse in the first months after giving birth, the worsening is unlikely to be permanent.
Talk to your doctor about whether to breast-feed. Most mothers with MS can nurse a baby, and it does not seem to increase the risk of flare-ups. On the other hand, some women with MS might find breast-feeding too tiring. Also, if you choose to breast-feed, you may need to wait until you stop breast-feeding to start taking your medications again.
So having MS does not mean you will have to deal with long-term negative effects from your pregnancy. You just need to consider the realities that you will have to deal with.