The thought of becoming pregnant can make even the healthiest women anxious. In addition to experiencing many physical changes including weight gain, increased bladder problems, and a shift in balance that can make walking more difficult, expectant mothers are also responsible for the health and wellbeing of a new life. Expectant mothers with multiple sclerosis (MS) may be even more anxious to care for a new life because they are not completely healthy themselves.
Multiple sclerosis (MS) is an incurable, autoimmune disease in which the body's defense mechanisms attack parts of the central nervous system. This can disrupt the communication between the brain, the spinal cord, and the rest of the body, causing symptoms like fatigue and weakness in the limbs that interfere with a person's ability to perform basic daily tasks.
Since MS can cause symptoms that hinder someone's ability to function normally, it is not hard to see why a pregnancy may be worrisome to a woman with MS. However, MS and pregnancy do not negatively affect each other in serious ways. While MS symptoms may actually improve during a pregnancy, pregnancy does not impact the course of MS long-term, and symptoms return after the pregnancy. MS is manageable both during and after pregnancy, and maybe most importantly, babies born to mothers with MS are no more likely to have birth defects or disabilities than babies born to mothers without MS.
Doctors believe that multiple sclerosis (MS) is an autoimmune disease. A healthy immune system protects the body by producing proteins called antibodies that fight off foreign threats including viruses, bacteria, and other germs. In an autoimmune disease, the body's immune system has trouble distinguishing these foreign threats from the body's own healthy tissues.
In the case of MS, doctors think that the body's immune system attacks part of the central nervous system called myelin. Neurons (the cells or building blocks of the central nervous system) communicate with each other through their projections, which are called axons. When chemicals pass through axons, they generate an electrical current called a nerve impulse. This nerve impulse travels from one neuron to another and passes along an informational signal, such as an instruction for a muscle to move, for example. Axons are bundled into groups called nerves, and nerves are surrounded by fatty sheaths called myelin. Myelin protects the nerves and acts as an insulator. It prevents the nerve impulses from leaving the nerves at the wrong point, and it also helps the nerve impulses travel more efficiently.
When a person has MS, doctors believe that some of the cells of the immune system somehow become sensitized to myelin, and they attack and damage it. This damage interferes with the central nervous system's ability to send messages to the rest of the body because the nerve impulses cannot pass through the nerves correctly without the help of myelin as an insulator.
Although doctors do not know exactly what causes MS, the disease runs in families, so there may be a genetic component. For unknown reasons, being female, being Caucasian, and having an infection with the Epstein-Barr virus (which causes mononucleosis) also increases the risk of developing MS. Finally, living farther away from the equator makes people more likely to develop MS, possibly because their bodies produce less vitamin D. The body produces vitamin D when the skin is exposed to sunlight, and vitamin D may protect against autoimmune diseases like MS.
When MS interferes with the central nervous system's ability to send messages to the rest of the body, it can cause a variety of symptoms. The symptoms of MS can go into periods of remission where they get better or disappear altogether, but they return during periods called relapses, attacks, or exacerbations. Symptoms of MS depend on the location and amount of myelin damage. Common MS symptoms include fatigue, bladder and bowel control problems, depression, pain and tingling throughout the body, muscle stiffness and spasms, numbness or weakness in the limbs, trouble walking, balance and coordination problems, sexual dysfunction, and vision problems.
While there is no cure for MS, doctors use different types of medications to treat MS. Some MS medications decrease the inflammation that occurs during MS attacks. This reduces pain and helps people return to a normal level of functioning sooner. Other medications modify the course of the disease by reducing the immune system's attacks on myelin. This slows the progression of MS symptoms over time and decreases the frequency of MS attacks. Still other medications treat specific MS symptoms including fatigue, depression, and muscle stiffness.
The sexual dysfunction symptoms of MS, including problems with vaginal lubrication for women and impotence for men, may make having sex more difficult, but MS does not affect a person's fertility.
Having MS does not increase the chance of serious complications in a pregnancy, such as preeclampsia (or high blood pressure related to pregnancy), premature birth, or spontaneous abortion, but it can make being pregnant more difficult. Weight gain during pregnancy can shift a woman's balance and make walking more difficult. If a woman already has balance problems and trouble walking as a result of her MS, these may become worse as the pregnancy continues and she gains more weight. Women with these problems as well as weakness in the limbs and coordination problems have an increased risk for falling during pregnancy, which can harm both the mother and the fetus. Thus, it may be necessary for women with MS to use walking assistance devices like crutches or use wheelchairs when they are pregnant.
Bladder and bowel problems are part of almost every pregnancy because as the fetus grows, it causes stretching and weakening in the muscles that control continence in the bladder and bowels. Additionally, as the fetus grows in the uterus (or womb) throughout a pregnancy, it presses on the mother's bladder, which prevents her from emptying her bladder completely during urination. This can increase the chance of an infection in her urinary tract. MS can also cause bladder and bowel control problems, so women with MS may have worse bladder and bowel problems during pregnancy than other women.
Similarly, fatigue is a symptom of both MS and pregnancy, which makes pregnant women with MS more likely to experience fatigue than other women.
Effect of Pregnancy on MS
While having MS may cause additional difficulties for a pregnancy, the pregnancy will most likely have the opposite effect on the mother's MS. Pregnancy actually reduces the number of MS attacks and improves MS symptoms, especially during the second and third trimesters.
MS attacks and symptoms may improve during pregnancy because there are increased levels of natural immunosuppressant substances, such as certain types of proteins, circulating in a mother's body when she is pregnant. As the name suggests, these substances suppress the immune system and could prevent it from damaging myelin.
Pregnancy may also improve MS symptoms because pregnant women have higher levels of natural corticosteroids (a type of hormone) than non-pregnant women. Corticosteroids reduce inflammation, which is a characteristic of an MS attack. By counteracting this inflammation, natural corticosteroids may help reduce pain and help parts of the body return to their normal levels of functioning sooner than they otherwise would.
Pregnancy does not impact the course of MS long-term, though. MS symptoms and attacks return after pregnancy because the mother's body chemistry goes back to normal. The chance of an MS attack is especially high during the first three to six months following the birth of the baby.
Managing MS during Pregnancy
Although MS symptoms and attacks lessen during pregnancy, they do not completely disappear, so it is still necessary to manage the disease. It is important for a woman with MS to plan her pregnancy and to talk to her doctor because some MS medications are safe to take during pregnancy while others are not.
The medications that are not safe to take during pregnancy are the disease modifying drugs. This type of medication affects the way that the immune system functions and includes drugs like beta interferons, glatiramer, natalizumab, and mitoxantrone. These medications should be avoided during pregnancy and breastfeeding because doctors are unsure about whether or not they can harm fetuses and babies.
The medications that are safe to take during pregnancy are corticosteroids, which improve MS symptoms by decreasing inflammation. These medications can be safe to use while breastfeeding as well, but their use during breastfeeding should be monitored carefully.
There are other ways to manage MS other than with medications. These methods include making healthy lifestyle choices such as eating a healthy diet, getting adequate rest, reducing stress, and exercising. Additionally, it is important to manage MS by maintaining emotional wellbeing through support groups, contact with friends and family members, and relaxation techniques. Making healthy lifestyle choices is even more necessary when a woman is pregnant because her choices impact the health of the fetus. Thus, women with MS should continue to manage their MS by living a healthy lifestyle during pregnancy.
MS does not increase the risk for any complications during labor and delivery. However, sometimes women with MS have symptoms that make labor and delivery more difficult.
For example, some women with MS have damage to their spinal cords that prevents them from being able to tell when their labor starts. Also, some women with MS have damage in the nerves and weakness in the muscles that are needed to push during delivery. This could mean that they need to have a Cesarean section (C-section). In a C-section, doctors perform surgery to take the baby out through the mother's abdomen. Although a C-section is major surgery, many mothers without MS also deliver their babies this way, and the procedure is relatively safe.
Babies born to mothers with MS are no more likely than other babies to have birth defects or disabilities. They are slightly more likely to have MS than other babies because there may be a genetic component to MS, but even this risk is small. Mothers with MS can breastfeed their babies if they choose to as long as they communicate with their doctors regarding which MS medications they can and cannot take while breastfeeding.
Since pregnancy does not alter MS long-term, it is important for mothers with MS to learn how to manage their disease along with the demands of raising children. Motherhood can be exhausting for anyone, so it is beneficial for women with MS to be prepared with plans for the care of their children if they become fatigued or experience MS attacks. Continuing to lead a healthy lifestyle is also a good strategy for mothers with MS because that will help give them the energy they need to care for their children.
Additionally, all mothers are at risk for developing depression after they give birth (called postpartum depression). Since mothers with MS are already prone to depression as a result of their MS, it is even more important for them to receive the support that they need from doctors, friends, family, counselors, and/or therapists to remain emotionally healthy.
MS can make pregnancy and motherhood even more challenging than they already are. However, by planning with doctors, family members, and friends and by taking steps to remain as physically and emotionally healthy as possible, women with MS can have successful pregnancies and families.