What are the risks of pregnancy with multiple sclerosis?

Question

Hello doctor,

I was diagnosed with multiple sclerosis (MS) three years ago at the age of 35, and I am finding it difficult to cope with how it is impacting my plans to have children. I am currently on interferon beta-1b injections, which have helped reduce relapses. Before my official diagnosis, I experienced an episode of optic neuritis that caused blurry vision in my right eye for several weeks. Since starting treatment, I have only had one minor relapse, with numbness in my left leg that went away after a few weeks.

My husband and I have been trying to conceive for the past eight months. However, my gynecologist advised me to consult a maternal-fetal medicine specialist before proceeding.

I am concerned that pregnancy might worsen my MS symptoms or trigger more relapses. Lately, I have been experiencing increased fatigue and occasional problems with balance and coordination, especially when I am stressed or tired. I also deal with occasional bladder control issues, which I find embarrassing.

I would like to understand the risks of pregnancy with MS. Are there medications that are safe to use during pregnancy and breastfeeding? And will stopping treatment increase my chances of relapse during or after pregnancy? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Pregnancy is generally safe and often beneficial for women living with multiple sclerosis (MS, a chronic disease where the immune system mistakenly attacks the protective covering of nerves, disrupting communication between the brain and body). With proper planning and regular medical care, you can lower the risks for both yourself and your baby.

How pregnancy affects MS: the “protective” effect:

During pregnancy, especially in the second and third trimesters, the number of MS relapses (flare-ups) can drop by up to 70 percent. This happens because the immune system becomes less active to protect the baby, which also reduces MS activity.

Medications that are safer during pregnancy planning:

Glatiramer acetate (Copaxone) - This is a disease-modifying treatment (DMT) that helps prevent relapses. It is considered safe when planning pregnancy and can usually be continued until a pregnancy is confirmed.
Natalizumab (Tysabri) - This may be used in women with highly active MS. It requires close monitoring, as stopping suddenly can lead to a return of strong symptoms (rebound relapses).

Medications are likely safe while breastfeeding:

Glatiramer acetate and interferons - These are generally considered safe during breastfeeding because only a small amount passes into breast milk.
Natalizumab - May also be safe, though more research is needed. Talk to your doctor for guidance.

Managing symptoms during pregnancy:

Fatigue (extreme tiredness) - This often worsens in the first trimester. Prioritize rest, drink plenty of fluids, and try light exercises like prenatal yoga.
Bladder issues - These may include urgency or occasional leakage. Pelvic floor exercises can help, and it is a good idea to avoid caffeine.
Balance and coordination problems - If you feel unsteady, physical therapy can help strengthen your muscles. A cane or walking aid may be useful for added support.

Working with your neurologist:

Plan the timing of your MS treatments (DMTs) around pregnancy.
Check your vitamin D levels, as low levels are linked to increased MS activity.
With the right support and planning, pregnancy can be a healthy and positive experience for women with MS.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.