Managing MS During and After Pregnancy

Disease activity during pregnancy

For some women with MS, pregnancy brings about fewer MS symptoms. This may be due to the body’s immune system being more tolerant of the growing human being inside. Clinical and MRI disease activity related to MS are suppressed, particularly during the third trimester. This connection has led to research using hormones such as estriol to treat MS. So far the studies have been small, showing modest benefit.

Disease-modifying therapy during pregnancy

Women with MS are encouraged to stop disease-modifying therapy (DMT) once they become pregnant, if they had not already stopped DMT use when trying to get pregnant. Women with MS who become pregnant while on a DMT should consider participating in a formal pregnancy registry such as the one sponsored by MothertoBaby.org or those hosted by pharmaceutical companies. Several small studies have reported outcomes related to the use of DMTs during pregnancy, particularly during the first trimester, but information is still limited. Data suggest that glatiramer acetate or interferon beta are safe to use. However, each person with MS needs to make personal decisions regarding DMT use and pregnancy in collaboration with her doctor.

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Modern MS Management During and After Pregnancy

Family Planning and Multiple Sclerosis

Multiple sclerosis is often diagnosed in young adults during their prime reproductive years. So pregnancy and parenthood are common concerns for many people living with multiple sclerosis. Contrary to what physicians thought decades ago, pregnancy does not make multiple sclerosis worse. With so many treatment options, family planning is an important part of disease management for men and women with MS.

Multiple sclerosis has no significant impact on the ability to conceive, on the development of the fetus, or the mother’s ability to carry to term. MS doesn’t seem to increase the risk of spontaneous abortions, stillbirth, cesarean delivery, premature birth, or birth defects. However, a recent study suggests that MS patients may have decreased ovarian reserve, a term used to describe the ovary’s capacity to produce egg cells that can be fertilized.

Paternal MS

A recent study of men with MS who fathered children found that paternal MS had no impact on birth weight or premature birth. Researchers also determined that factors such as disease duration and disability did not impact birth outcomes. Data regarding semen quality is limited, but one study reports lower total sperm counts, reduced sperm motility, and increased percentage of abnormally formed sperm in men with MS.

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Family Planning in the Modern Day of MS

If Not For RA or MS, Would I Still Be Childless?

When I was around 20 years old, I had hopes that I would complete college, marry my sweetheart, and that we would have 3 kids before we turned 30. It was a nice dream, but instead I went to graduate school, we broke up, and I continued on to a doctoral program after completing my Master’s degree in Music Performance. Serious relationships took a backseat.

Just before turning 30 years of age, I moved to the Washington, DC, area to check out the performance opportunities. I wasn’t concerned with finding ‘the right man’ and starting a family, instead I was working on building a successful freelance career which was really picking up nicely when I first experienced an attack of optic neuritis. Until I was diagnosed with MS five years later, things were moving along smoothly.

Shortly before the MS diagnosis, I was introduced to ‘the guy.’ Of course I didn’t know that Rob would become ‘the guy’ until I had known him for a little while. Rob was there when the MS diagnosis became official; he was there for lots of tears and hugs; and he was there when I woke up in the middle of the night screaming and crying in pain from early RA symptoms.

I was 38 when I was finally diagnosed with RA and one of the first things we (my doctor and I) did was begin a medication for which pregnancy was strongly warned against (ie., methotrexate). This was a little late in life to consider starting a family, but it wasn’t TOO late. Women are having children even in their 40s nowadays.

Sometime after my RA symptoms were brought under control, I did run a small experiment to see whether or not I might consider going off treatment to prepare for a potential pregnancy. I stopped taking my methotrexate for a short period of time. Unfortunately, it was only a matter of 2-3 weeks before symptoms began to return. Knowing how AWFUL the pre-diagnosis, no-treatment time period was for me, I started back on methotrexate immediately.


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If Not For RA, Would I Still Be Childless?

Talking to Your Doctor About Family Planning and MS Drugs

Some of the newer MS medications are contraindicated with pregnancy, including drugs that must be stopped for a period of time before a patient attempts to become pregnant, such as Aubagio or Gilenya. However, approximately half of all pregnancies are unintended, whether mistimed, unplanned, or unwanted, according to the CDC. So it is important to do some planning in advance to prepare yourself for the unexpected.

Talking to Your Doctor

Neurologists have much area to cover in a brief period of time during appointments. Family planning and reproduction are topics that likely do not rank in the top ten things to discuss with your MS doctor.

My neurologist may have asked once, ten years ago, whether starting a family was something I needed to discuss. Currently, my rheumatologist asks during each appointment whether my husband and I plan to have children and whether we are using consistent birth control as one of my medications is known to cause birth defects and miscarriages. It doesn’t matter that I’m almost 47 years old, my doctor still asks.

In addition to discussing symptoms and disability, please talk to your doctor about issues related to sexual activity, pregnancy, medication use, contraception, and family planning. Listed below are medications (included in the HealthCentral article), commonly used with MS patients, which have been categorized as carrying some level of risk to an unborn fetus. Research other medications on websites such as drugs.com.

If the topic of pregnancy, family planning, and MS medications is one which concerns you, please take time during your next doctor’s visit to discuss these concerns. If you do become pregnant while taking one of these medications, you can contact patient pregnancy registry programs to report drug exposure.

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Drugs to Take (And Not to Take) When Pregnant with MS

Just Got Pregnant and Take MS Drugs? Here’s What You Should Do

Learning that you are pregnant can be an exciting event. But unexpectedly becoming pregnant while you are taking powerful medications can cause panic and concern. For many medications, research studies have not been thoroughly conducted to ascertain the safety of specific medication use before or during pregnancy.

What to do once you learn you are pregnant

• Contact your doctor. The best person equipped to work with you in deciding what you need to do to ensure the safety of your unborn child is your healthcare provider. If you have MS, contact your neurologist. If you have RA, contact your rheumatologist. You get the idea.
• Women who become pregnant while using prescription medication can contribute to the body of evidence-based information regarding the exposure of medications during pregnancy and while breastfeeding. Contact MotherToBaby.org, a service of the non-profit Organization of Teratology Information Specialists (OTIS), to speak with experts, obtain information, and register with research studies. 
• Contact the manufacturer of the medications you are taking. Some companies offer programs that enroll patients who become pregnant into studies to track their progress and outcomes.

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Pregnant with MS: Drug Exposure

Is Abortion Common in Patients Using RA Drugs?

A new study published in the American College of Rheumatology (ACR) journal, Arthritis Care & Research, suggests that medications used to treat rheumatoid arthritis may affect abortion rates in women.  Some drugs used to treat RA, such as methotrexate, may be harmful to a developing fetus.

In North America, up to 50% of pregnancies are unplanned and that nearly half of unintended pregnancies are terminated (Winner, 2012).  Rheumatoid arthritis, which is more common in women than men, can affect individuals during their reproductive years, putting them at risk for unplanned pregnancies.

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Abortion Rates in RA Patients Using Methotrexate or Anti-TNF Drugs

Carnival of MS Bloggers #126

Welcome to the Carnival of MS Bloggers, a bi-weekly compendium of thoughts and experiences shared by those living with multiple sclerosis.

Happy Belated Carnival
from the Newly Married Lady

Rob and Lisa

(a few select photos from the big day)

Pregnancy and MS – Reducing Risk of Relapse After Delivery

by Dr. Yumi of Universal Balance Consultations

OK, here’s Part II of my article on reducing the risk of relapse after delivery. Remember in Part I, we talked about how much your risk increases after delivery, and how
important rest is to recover properly and avoid relapse. We also included some tips to make sure you get that rest.

PART II
Nourish your body for post-delivery recovery

Next is diet. I can’t stress the importance of proper diet enough. Not only will you be providing nourishment for yourself (and the baby if you’re breast-feeding,) a nutrient rich diet with some selected items will actually speed your healing process. And by recovering and strengthening the body, you’ll be reducing your chances of relapse.

“So what foods are best to nourish, and promote healing and strength after delivery?”
As soon as you get home from the hospital, you should make a big pot of Recovery Soup. It should have the following ingredients:

• Lamb, pork kidney or carp (one or more)
• White spring onion or white scallion, (the white parts are especially important)
• Ginger (freshly crushed or cut into thin slices is best)
• Dong quai (Angelica sinensis)

After that, just add more of your favorite vegetables, salt to taste and maybe some light seasoning. But you don’t want to use any type of spicy ‘hot’ seasoning, (chili pepper, cayenne pepper, and the like.)

There are other herbal supplements you can use to recover and nourish if you’re interested. But the Recovery Soup will make a great base to start from. I recommend you have a bowl or two each day for at least one month after delivery, or as long as you’re breast-feeding.

For the remainder of your diet during this period, you want to be eating as many nutrient rich foods as you can, which means include fruits and vegetables in all your meals. Also, stay away from fatty meats and junk food. I shouldn’t have to say here to avoid buckets of
greasy fried chicken and value meals from the local fast food joint. But I will. Avoid them!

These should be a very last resort; so maybe suggesting specific dishes you’d like to your friends in the cooking rotation would be a good idea. (See Part I) You want to strike a balance between healthy and tasty.

With the combination of rest and a nutritious diet, you should be well on your way to recovering from your delivery, and thereby reducing the chances of your symptoms flaring up. If you’re not interested in the diet, then the best thing to do is to just rest as much as possible after delivery. And avoid exerting yourself at least for a month or two. This will allow your body to heal. But I highly recommend you supplement with your diet.

Great, now you know how to regain your strength and avoid relapses. But you may still be wondering what it is that makes you more prone to relapses just after delivery.

What’s the deal with pregnancy and relapses?


According to oriental medicine theory, the kidneys are a major energy center, and govern the brain, back, spinal cord, bones, and bone marrow. The kidneys also store prenatal energy and control birth, growth, maturation and sexuality, so they’re one of the main organs that support pregnancy.

MS patients have lesions in the brain and/or spinal cord, which means your kidneys are probably already weak. (The kidneys could be the original problem, or they could have been weakened by some other imbalance.) Nevertheless, pregnancy, delivery, breast-feeding, sleep deprivation, overexertion, or any kind of mental stress, further burden
the kidneys.

When the kidneys are weak and overtaxed, the risk of relapse increases.
You’re particularly at risk if you’re breast-feeding because your body is still weak from the delivery, and your kidneys are providing nourishment for both you and the baby. This especially drains your kidney energy, so you might want to consider switching to formula after a month or two. However long you breast-feed, though, be sure to have the Recovery Soup for the duration.

You just don’t want to take unnecessary chances. Everything about your pregnancy and delivery is putting a strain on your kidneys. So it’s important in the first few months after delivery to properly heal and allow your body and kidney energy to strengthen.

All right, so now we know what’s going on with your kidneys and why women with MS are more prone to relapses. We’ve also learned how we can avoid those relapses. By following the guidelines I’ve presented, you can rest easier knowing you’re taking appropriate steps to maintain your health.

I hope this information has been useful to you and will help keep your own pregnancy episode-free. Especially if you have MS, you need to take good care of yourself, so you can in turn take care of that precious little person who’s just come into your life.

I’ve enjoyed presenting this info here and look forward to discussing further MS topics with you. Thanks for your time.

Dr. Yumi Izumisato

This concludes the 126th edition of the Carnival.  The next Carnival of MS Bloggers will be hosted here on November 8, 2012. Please remember to submit a post (via email) from your blog of which you are particularly proud, or which you simply want to share, by noon on Tuesday, November 6, 2012.

Thank you.

Comments for this post.

Do infertility treatments have an effect on MS?

A recent study published online June 11 in the Journal of Neurology, Neurosurgery, and Psychiatry confirms the results of prior studies suggesting that infertility treatments have an impact on MS relapse rate.  Hellwig K, et al (2009) found a statistically significant increase in relapse rate in 23 MS patients who underwent hormonal stimulation associated with assisted reproductive technology (ART), which includes in vitro fertilization (IVF).

For the current study, researchers obtained data related to MS patients and IVF procedures from 13 French university hospital databases or referring neurologists.  From 1998 to 2008, 32 women with MS underwent a total of 70 IVF treatments.  In 48 cases gonadotrophin releasing hormone (GnRH) agonists were used, GnRH antagonists used in 19 cases, and information is unknown for three treatment cycles.

Annualized relapse rate (ARR) was calculated for different times periods before and after IVF treatment.  As shared by MedPageToday, 19 women in the study had a total of 26 relapses during the three months after the IVF treatment.  Data analysis revealed that the ARR was significantly higher during the three-month period following IVF treatment (mean ARR 1.60) compared with the three months prior to IVF (mean ARR 0.80) and a three-month period one year before the procedure (mean ARR 0.68).  This represents double the risk of relapse in the three months post-IVF as compared to the three months before IVF.

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Pregnancy, Infertility and Hormones: MS and Motherhood