Can You Get Pregnant With Multiple Sclerosis

Can I Breastfeed If I Have Ms

Pregnant With Multiple Sclerosis

You can breastfeed with MS if you want to and youre able to just like anyone else.

MS symptoms like fatigue, or some MS treatments might affect your choice. But you should make the choice that works for you and your baby.

Breastfeeding wont make your MS worse, and MS cant be passed on through breast milk.

Some research has suggested that people who feed their baby with only breast milk might have a lower chance of relapse after giving birth. But this is only one thing to consider about breastfeeding, and some women will still have a relapse even if they choose to breastfeed.

If you breastfeed, you might want to try and store some breast milk in the freezer. This can be a back up if MS symptoms get in the way of feeding.

Some people choose to combine breast feeding and bottle feeding.

If youve any concerns about breastfeeding, speak to your MS nurse, midwife and health visitor. Your neurologist can help you decide about taking a DMT while breastfeeding.

You can safely take some DMTs if you breastfeed, but not all. We’ve got more on DMTs and breastfeeding in the question below.

You can take steroids to help manage an MS relapse if youre breastfeeding.

Only very small amounts of steroid pass through the breast milk to the baby.

If you want to keep this amount at its lowest, you could wait 2-4 hours after each steroid treatment before you breastfeed.

Does Your Ms Raise Your Offsprings Risk Of Ms

The cause of MS is unknown, but it is believed to have a genetic component. That means that as you contemplate pregnancy, its good to consider your family history of MS.

The risk of developing MS for someone without a first-degree relative with MS is about 1 in 750 to 1,000, according to the National Multiple Sclerosis Society . Children born to a mother with multiple sclerosis have a 3 to 5 percent risk of developing the disease, according to the Cleveland Clinic.

The fact of having MS affects different adults family-planning decisions differently. For some its a reason not to have children or not to have more children. For others it does not factor into the decision of whether to have children. The right choice is the one thats right for you.

Outcome Of The Children Born To Mothers With Multiple Sclerosis

A three year prospective study from the Middlesex Hospital reported a normal distribution of weight and head circumference in babies born to mothers with multiple sclerosis. There is no reported evidence to suggest that the children of women with multiple sclerosis are in anyway physically or mentally disadvantaged. The increased frequency of relapse seen in the puerperium may, however, impact on the important early relationship between mother and child. A mother with multiple sclerosis may be temporarily less able to care for her new child if she has a significant relapse. Fatigue is well recognised as a feature of multiple sclerosis and may be more likely to be a problem postpartum than at other times. These potential problems should be discussed and incorporated into plans for maternity leave and support after the birth. Given the increasing use of immunosuppressive agents appropriate advice on contraception is essential.

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Can I Take Dmts While I Breastfeed

You can take some DMTs and breastfeed, but others should be avoided. This is because some drugs can get into your breast milk and could harm your baby, but others cant.

For example, with beta interferons and glatiramer acetate, the Association of British Neurologists advise that the benefits for the baby from breastfeeding are greater than any risks.

But some other drugs, including fingolimod and cladribine shouldnt be used when breastfeeding.

Your neurologist can give you advice about your DMT and safe breastfeeding.

The ABN has detailed guidance about pregnancy and MS for health professionals:

Can Mothers Who Have Ms Breast

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Any mother who wishes to breast-feed is encouraged to do so, provided she has the strength to do it safely and does not require any medications that might be unsafe for the baby. It is recommended that women talk to their neurologist and GP about the best time to recommence their MS medications. Since fatigue can sometimes affect milk production, it is important for the new mother to eat well, get plenty of rest and have sufficient help available in the home.

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Q: What Is The Risk For Rebound Disease Activity Following Washout

A: Women who were treated with S1P modulators or natalizumab prior to conception may have an increased risk for severe rebound disease following medication withdrawal.34 Due to the risk of rebound disease activity in patients treated with these medications, changing to an alternate therapy may be considered prior to discontinuing contraception .15-17

Anti-CD20 agents infused intravenously confer prolonged protective effects against MS relapses for several months following administration. They are not recommended to be routinely administered during pregnancy but can be administered prior to conception in patients with highly active diseases. The FDA-approved prescribing information recommends that women continue contraception for 6 months following the last treatment of ocrelizumab and 12 months following the last treatment of rituximab.18-20 Ofatumumab is administered by subcutaneous injection, and the FDA-approved prescribing information recommends contraception for 3 months following last treatment.21

Ms Drugs And Breastfeeding

Reder advises women who had active MS before pregnancy to restart their MS disease-modifying therapy as soon as possible after delivery. Some MS drugs are not recommended while youre breastfeeding, because its not known whether the drug gets into the breast milk. Your doctor may know ways to combine breastfeeding and MS therapy, Reder says.

Having an ongoing dialogue with your MS medical team, including your ob-gyn, will help you reach the best decisions for your personal circumstances.

Additional reporting by Susan Jara.

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Good News For Patients

For Dr. Sicotte’s patient Michelle Buser, this was welcome news.

Michelle, who’s had MS for 16 years, had been planning a family when she moved to Canada from LA. Her new doctors there were concerned that giving her an epidural could leave Michelle in a wheelchair and pushed her toward having a C-section under full anesthesia.

Dr. Sicotte worked with Michelle’s new care team to create a birth plan so she could avoid an unwanted C-section. Michelle delivered healthy twin girls in 2018 with no surgery or complications.

“So many doctors don’t know enough about MS, and sometimes even neurologists aren’t MS specialists,” says Michelle. “It’s important to do your own research and be your own advocate before making a life-changing decision.”

Disease Modifying Therapies During Pregnancy

Multiple Sclerosis and Pregnancy

Disease modifying treatment during pregnancy needs to be adjusted individually taking into consideration the patients priorities, age, severity of disability, clinical and MRI disease activity, the rate of relapses and the risk of continuing or terminating the treatment . According to the US Food and Drug Administration , the majority of drugs registered to treat MS are labeled as class C, meaning data of adverse effect was obtained in animal reproduction studies however, despite the possible risk, pregnant women may benefit from the drug, but there is not enough reliable evidence and well-controlled studies in humans . It is worth noting that DMTs are not certified during pregnancy, with the exception of glatiramer acetate 20 mg/mL . Recently there was an analysis performed evaluating pregnancy outcomes in women exposed to DMTs during the first 3 months of pregnancy or at the time of severe disease reactivation. The most frequently used drugs included interferon- , natalizumab , fingolimod and dimethyl fumarate . The results reported no substantial differences in delivery outcomes between the groups who were exposed and not-exposed, as preterm birth rates were 5% against 3.2%, abortion 10% against 11.3%, and no data of birth defects were obtained .

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The Impact Of Ms On Pregnancy Outcomes

Two retrospective cohorts and one randomized clinical trial were included. The fertility of patients with sclerosis does not seem to be affected by the evolution of the disease or approved treatments, and there is no increased risk of spontaneous miscarriage, C-section, or number of ectopic pregnancies. However, these patients have more preterm labor, peripartum infection, and hereditary congenital malformations, although they present other associated comorbidities and are older on average compared to individuals without MS, which makes it difficult to analyze isolated data. Women with MS have reportedly fewer children, primarily because a diagnosis of MS negatively affects the decision to have children.

Q: Are There Special Considerations For Delivery

A: For most women, we have no special recommendations for delivery. Additional considerations depend on the individual patients needs, such as planning for use of assisted delivery methods and/or Caesarean section in women with significant disease-related disabilities. The use of any anesthetic type is acceptable when clinically indicated.31 Assisted vaginal delivery or Caesarean section may need to be considered in patients with severe disabilities.2

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What Multiple Sclerosis Drugs Are Safe To Take While Trying To Conceive Or During Pregnancy

  • If you have MS and are trying to get pregnant, talk to your doctor about what medications you may be able to take. Disease-Modifying Therapy is not approved for use during pregnancy as it may harm a developing baby. The one exception is glatiramer acetate . Interferon betas including interferon beta-1a and interferon beta-1b may also be safe to take during pregnancy.
  • Many drugs used to for treatment of MS symptoms may also have adverse effects on a fetus and should not be used during pregnancy, including baclofen for spasticity, fluoxetine for depression, and solifenacin succinate for bladder management.
  • Corticosteroids for acute MS relapses can often be taken during pregnancy.
  • All forms of anesthesia are considered safe for women with MS during labor and delivery.
  • Disease-modifying drug therapy is not recommended during breastfeeding because it is unknown if it passes into breast milk

What Medications Are Safe For Use During Pregnancy And Breast

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As a general rule, the use of any medications during pregnancy and breast-feeding should be done cautiously and under the supervision of your GP. If at all possible, a woman who wishes to become pregnant should consult her GP prior to conception about any medications she may be taking. The GP will eliminate any unnecessary medications and substitute safer ones where required. Both men and women taking Disease Modifying Treatments who wishes to start a family should review treatment options with their neurologist or GP. A woman who becomes pregnant while taking any medications should review them with her doctor as soon as possible. Similarly, men may also need to cease use of these treatments to assist spermatogenesis and should seek the advice of their treating doctor.

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Will Pregnancy Make My Ms Worse

If you get pregnant it wont make your MS worse in the long run.

Relapse risk while youre pregnant

Research shows that MS seems to be less active during pregnancy. This is especially true during the last 3 months . Hormone changes probably play a role in this positive effect.

For most people, the risk of having a relapse is lower when theyre pregnant. But this risk can go up if you stop taking certain DMTs. Thats because stopping the treatment outweighs the effect of being pregnant.

If youre thinking of getting pregnant, or you discover you are, discuss your DMT options with your neurologist. That way you can decide whats best for you and the baby.

Relapse risk after the birth

In the first 3 months after the baby is born, the risk of a relapse goes up. We think this happens because hormones return to their usual levels.

On balance, being pregnant doesnt change your risk of relapses over the course of a year. Relapse risk reduces while pregnant, then increases for the first 3 months afterwards.

Relapse risk and fertility treatments

If you have fertility treatments that use drugs to alter your hormone levels, like IVF, you might have a bigger risk of relapses. Your neurologist can discuss this with you before you start any fertility treatments.

What Can I Expect During Pregnancy

If MS affects your ability to walk, you may notice that walking becomes even more difficult during pregnancy. This is because the weight you gain during pregnancy can shift your balance. You might need to be extra careful to avoid falls. You may need crutches or other walking assistance devices, or you may need to use a wheelchair.You may also notice that you become tired more easily, especially later in the pregnancy. Plan ahead so your schedule allows you to get plenty of rest. Talk to your partner, family and friends if you need help taking care of other children, doing chores or running errands. Ask for the support you need.Urinary tract infections are more common in pregnant women who have MS. Drink plenty of water and let your doctor know if you have any symptoms. Your doctor may want you to have monthly urine tests to make sure a UTI doesnt sneak up on you.

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What Problems Can Multiple Sclerosis Cause During Pregnancy

  • Having multiple sclerosis can make delivery more difficult.
  • Pain sensations may be altered in people with MS, which means a woman may not feel pain with contractions. This can make it difficult to tell when labor begins.
  • The pelvic muscles and nerves used for pushing during delivery may also be weakened. Some women with MS may require the help of forceps or vacuum to assist with delivery, or may need a Cesarean birth .

Q: Is Breastfeeding Safe For Patients On Disease

Info: Multiple Sclerosis and pregnancy

A: In general, the decision to breastfeed and the duration of breastfeeding is deferred to the patients decision after conferring with their obstetrician/pediatrician. Exclusive breastfeeding is recommended in most cases for about 6 months due to known benefits to the infant.38 However, the decision to breastfeed is associated with a delay in resumption of DMT , and therefore the individual patients disease characteristics must be considered. The effect of breastfeeding on relapse rates has previously been controversial.34 It is believed that exclusive breastfeeding for at least 2 months may decrease the risk of relapse.12,23,39-41 The recommendation to shorten breastfeeding duration may be made in patients considered to be at higher risk of relapse to resume DMT.

If a patient develops a relapse while breastfeeding, use of corticosteroids may be considered. Transfer of methylprednisolone through breastmilk is thought to be minimal and may be further minimized by delaying breastfeeding for 2-4 hours after infusion .44 For patients receiving oral steroids, the dose ingested by the infant through breast milk is thought to be negligible. Because there is a small risk of growth retardation in the infant, however, breastmilk may be discarded for 24-48 hours following treatment out of an abundance of caution.60

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Perinatal And Postpartum Depression

Perinatal depression is defined as depression that occurs during pregnancy or during the first year after childbirth.

People with MS are already at risk for depression, due to the psychological impact of dealing with a chronic illness. Women with MS have a higher likelihood of developing perinatal depression.

Women who are diagnosed with MS during the postpartum period report the highest levels of depression, while women who are diagnosed before pregnancy have similar rates of depression as women without MS.

How Does Pregnancy Affect Ms

“Pregnancy actually has a calming effect on MS,” says Thrower. “Your immune system has learned to tolerate a foreign body already your MS and so carrying a baby is not difficult for your body to adapt to.”A study from Norwegian researchers found that there is approximately a 70% decrease in relapse of MS symptoms during the third trimester of a womans pregnancy.

This is in part due to a specific type of estrogen associated with pregnancy, estriol, which appears to keep MS in check it’s even used as an MS therapy. Levels of an estriol spike during pregnancy, explains Thrower. This hormone appears to have a protective effect, resulting in a lower risk of MS relapses and new lesions on MRIs.

Some of the medications we use to treat MS are contraindicated in terms of pregnancy and breastfeeding,” advises Smith. “However, most women do not require treatment during pregnancy, because of how the risk of relapse significantly decreases.

Six months following childbirth, there is the risk of relapse, but we also know that breastfeeding can extend the protective effects of pregnancy, adds Thrower.

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Could Dmts For My Ms Harm My Developing Baby

Some DMTs could harm babies developing in the womb. If you are planning to try for a baby, or youre pregnant already, let your neurologist know straight away. They can discuss your best plan of action explaining the benefits and risks for you and your developing baby.

You and your neurologist will consider how active your MS is, and what DMT you take. The balance between benefit and risk will be a personal one.

With beta interferons and natalizumab , you might agree to keep taking it for some months into the pregnancy, or to come off it before you get pregnant. One DMT, glatiramer acetate , is licensed for use while youre pregnant.

But some DMTs are not considered safe during pregnancy. For example, if you take fingolimod or teriflunomide you should speak to your neurologist about stopping before trying for a baby.

When you start taking some DMTs, you might be advised to use contraception. You can read more about contraception and DMTs on our Periods, contraception and MS page. It includes information about sperm and DMTs.

If you stop a DMT because you plan to get pregnant, youll usually need to do this a few months in advance. Thats so the medication in your body drops to a safe level. Depending on the drug, that could take between one and 12 months.

Always get advice from your neurologist before you stop taking a DMT.

The Association of British Neurologists has detailed information written for neurologists. It includes recommendations about DMTs and pregnancy.

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