MS and Pregnancy

Multiple Sclerosis (MS) is more common than most people realise. It has a long history and is well documented through the centuries. Specialists at Southampton hospital tell us more.

Who gets MS, and what is it?
MS is found in specific parts of the world and in specific groups of people. It is most commonly found in those people who are descendents of Vikings (Celtic peoples) and in temperate climates such as northern Europe, Canada, Iceland and North America. It does not exist in some races such as the Inuit (Eskimos), and is rare in others (such as Orientals). The nearer you get to the equator, the less you will find it. It is thought to be a condition where the body’s own immune system attacks nerves in the brain and spinal cord, and occurs because of genetic factors that make someone susceptible to certain “triggers” at a critical time in life. It is not a hereditary disease and you cannot “catch” MS. We still do not fully understand what causes MS and so do not have the cure.

What symptoms do people with MS experience?
This results in damage that may cause a wide range of problems affecting sensation, movement and co-ordination. MS can also cause problems with fatigue, memory and depression. People with MS may have different types of the condition, with different symptoms, varying in severity, but there is always a progression of problems. The most common form is relapsing/remitting MS. This is when people have attacks (relapse) and then get better (remission) for many years before becoming more chronic. A few have a bad attack from which they never make a full recovery, with progressing disability over the years.
MS is the commonest cause of neurological disability in young people, but we now consider it a manageable condition, not an “incurable disease”. We have some treatments to help reduce the number of attacks that occur and slow down the progress of the condition.

Should I have a family?
The decision is based on the many factors that all women must consider. The decision should not be based on the MS alone. Women with significant physical disability have experienced great joy from their children. It should be an informed joint decision shared with her partner/family and the doctor.

What about pregnancy?
Women with MS have normal fertility, normal pregnancies and normal babies and there is no evidence to suggest that one or more pregnancies accelerate the condition. Women with MS are generally very well during the second and third trimester and are more likely to have a relapse in the 6 months postpartum period. Prompt treatment of any infection (particularly urine) is important in pregnancy.

What about birth?
Women with MS should anticipate, and look forward to, a normal birth and delivery. Management of pregnancy, labour and delivery should be routine and there is no medical reason to avoid epidural anaesthesia if the woman and her obstetrician prefer it. Ensuring good health, careful planning and pre-natal rest is key to a successful pregnancy and birth. Breastfeeding is to be supported and the use of a breast-pump can reduce fatigue and allow the partner (or family member) to take over in a planned way.

What about parenting?
MS is not contagious or hereditary. It cannot be passed to a spouse or relative. There is an increased lifetime risk of MS in the offspring of mothers or fathers with MS, in the range of 2% to 3%. The actual risk of transmission is very small. Children of a parent who has a lifelong condition often grow up to have a greater sensitivity and patience than the average population.

Interesting facts and figures

  1. Over 85,000 people in UK have MS.
  2. More women then men get MS. (2:1)
  3. Less than 2 in 5 people with MS ever need a wheelchair.
  4. It is not infectious, nor hereditary, nor fatal.
  5. In the UK the annual incidence is about 8 in every 100,000 with approximately 50 new cases diagnosed each week.
  6. The nearer to the Equator, the less you will find it.
  7. Eskimos don’t get it.
  8. Some people think it has existed for many centuries and has evolved from a related disorder, Devics disease (neuromyelitis optica).
  9. The neolithic founders of Europe introduced neuromyelitis optica.

What should women with MS be aware of if considering a family?
The MS will not harm the baby.
Prenatal iron/folic acid should be discussed with the Obstetrician.
All medication must be reviewed, and temporarily suspended if necessary, until after breastfeeding. Medication can be resumed after breastfeeding. Nursing mothers should avoid medication and seek the advice of their doctor.
Fatigue and depression are significant symptoms of MS, but can also be pre- and post-partum features, so talk to your GP/Midwife/MS nurse/Obstetrician/Neurologist if you are worried and have MS.
Ensuring a good network of practical support in the first 6-12 months after the birth is key to successful early motherhood. If you, or your family, have any questions, queries or concerns (no matter how small, unsure, uncertain or “silly” don’t hesitate to ask; the only “daft” question is the one never asked. A woman with MS is entitled to a fulfilling life with or without children. It is her choice, and there is no right or wrong. It must be an informed, wise and balanced choice.