Miriam's casebook - Mother with MS
When Kathy, now 29 and 14 weeks pregnant, developed multiple sclerosis at 23, a year after her marriage to Tom, both were devastated. They believed that Kathy's MS would make it harder for her to conceive, possibly even make her infertile. They worried that it wasn't good for a woman with MS to become pregnant because it could make the condition worse, with serious relapses and increased disability.
Getting new information
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Five years after her diagnosis Kathy's walking was still steady, her eyesight was hardly affected, and she had no troublesome urinary symptoms or vertigo. She and Tom badly wanted a baby so they decided to see an obstetrician.
Kathy and Tom were given an encouraging picture by the obstetrician. He explained that MS doesn't affect a woman's fertility and has no effect on pregnancy, labour, or delivery. In a study of 36 pregnant women with MS, the only problems noted were two cases of mild vomiting. There's no increase in miscarriage, complications, malformations, or stillbirths.
A good MS prognosis
Kathy wondered whether pregnancy would make her MS worse. I reassured her that many research studies suggest that pregnancy is in fact a protection for women with MS. This is probably because the natural state of immuno-suppression that happens in pregnancy to prevent a woman from rejecting her baby also suppresses the inflammation that causes nerve and brain damage in MS. On the other hand, there's a slightly increased risk of a flare-up for three to six months after the birth. Between 40 and 60 per cent of women have a relapse during this time - 20 per cent of these suffer from permanent side effects while 80 per cent go back to their pre-pregnant state of MS. Pregnancy does not appear to affect the long-term course of MS.
I reassured Kathy that the management of her labour and delivery would follow normal medical routine. She could be given analgesics - gas, injection, or epidural - and these would have no effect on her MS. A Caesarean would not affect her MS, nor would a forceps delivery.
Possible health risks
Tom was concerned that MS might be passed on to their child. I explained that in an area with a high prevalence of MS, one person in 1,000 would be likely to develop the disease. A study has shown that among children of people with MS, the figure could rise to one in 100. Dietary and genetic factors may be involved, although nothing has been proved. Most people feel that the risk of their child having MS is not great enough to stop them from trying to conceive.
Stopping MS medication
Kathy was worried that the drugs she's given for MS might harm her developing baby. I told her that in the first 12 weeks of pregnancy a woman is never given drugs, even if she does have MS, unless her life or the life of her baby is in danger. Drugs to stop painful muscle spasms would be discontinued before she conceived, as would long-term anti-inflammatory therapies. Drugs that help to control urinary frequency or incontinence would also be stopped. Steroids, which are only given if either the mother or the baby's life is in danger, are hardly ever needed during pregnancy.
When Kathy became pregnant, her obstetrician referred her to a neurologist who could give advice throughout her pregnancy and after the birth of the baby.
Ms after birth
Kathy wanted to know whether her MS would affect her ability to feed and care for her baby. There are no medical reasons for her not to breastfeed. It's extremely important for her to rest, though, so she'll need to have help with her baby and express milk so someone else can give night feeds. She was also worried that having a baby to look after might increase the sense of insecurity she already has because of her MS. Tom was able to calm Kathy's fears on that score.
Happily pregnant
Kathy and Tom thought about what they'd been told, and read the ARMS (Action for Research into Multiple Sclerosis) booklet, MS and Pregnancy (see Addresses). They decided to try for a baby, and Kathy is now 14 weeks pregnant. She's going to routine antenatal clinics and seeing her neurologist once a month. Kathy's doctors have told her that there's no need for special testing or monitoring. She's being given iron to avoid anaemia and her doctors are on the look-out for warning signs of a urinary tract infection, which would need prompt treatment. So far her pregnancy is going normally and her MS remains unchanged.
A mother with MS will need to rest regularly during the day. I suggested to Kathy that she should stop doing things if she gets breathless, learns to catnap in her spare time, takes two sleeps a day of at least 30 minutes each, and goes to bed early, say not later than 9.30pm.
Kathy's baby
There's every expectation that Kathy's baby will develop normally and be born in a straightforward way without the need for any special medical intervention. I explained to Kathy that her baby cannot inherit MS by transmission across the placenta, and the risk of transmission through genes appears to be very small.
While in the uterus, Kathy's baby won't be at risk from the drugs given for MS because Kathy will be advised to stop taking medication. I advised Kathy to check with her doctor before starting drug treatment again following her baby's birth so her baby won't be at risk from any traces of drugs in her breast milk.
I explained to Kathy that breastfeeding would not present any difficulties and that Kathy would be wise to express milk so that someone else can help out by occasional bottlefeeding while Kathy rests to help keep her milk supply up. I suggested she practise breastfeeding a doll before the birth while lying on her bed or sofa with the doll resting on a pillow or cushion. That way Kathy can learn to conserve her energy as much as possible.
Miriam's top tips
The good news is that MS has no effect on a woman's fertility or on her ability to conceive, carry to term, and deliver a healthy baby. Bear in the mind the following:
- consult your neurologist before becoming pregnant, so you can be advised on the best time to stop taking medication before conceiving
- rest as much as you can during your pregnancy and learn to catnap as often as you need to recharge your batteries during the day
- be prepared for the possibility of a flare-up in MS symptoms three to six months after delivery.
Posted 16.11.2010
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