Pregnancy and multiple sclerosis

Can men and women with have children?

Yes, multiple sclerosis has no direct effect on fertility in either women or men. Pregnancy and childbirth are also free of complications in most MS patients.

A pregnancy with multiple sclerosis is not a high-risk pregnancy per se. However, as with any pregnancy, complications can still occur. In particular, the rate of complications and relapses depends on the course of the MS and the immunomodulatory medication.

Some medications are contraindicated during pregnancy and should therefore not be taken.

After the birth of the child, the risk of relapses is often temporarily increased, but returns to normal. The long-term course of MS is generally not affected by pregnancy.

‍

‍

Is MS hereditary?

No. According to current scientific knowledge, MS is not a genetically inherited disease. Nevertheless, there are genetic factors that are associated with MS. The risk of children of MS sufferers developing MS themselves is 2% higher than for children of non-MS sufferers. If both parents have multiple sclerosis, the risk increases to up to 20%.‍

‍

‍

Is the risk of relapses increased during pregnancy?

Approximately 25% of pregnant women develop a relapse during pregnancy. However, larger studies have shown that the overall relapse rate is reduced during pregnancy. This is most likely due to a slight change in the immune system during pregnancy. The relapse rate is lowest in the third trimester in particular.

However, there is a slightly increased risk of flare-ups in the first three months after giving birth, which then normalizes again. If there was a high level of disease activity before pregnancy, the risk of developing a relapse after pregnancy is particularly high. Studies have also shown that artificial insemination is associated with an increased risk of relapses.

‍

‍

Can MS medication be taken during pregnancy?

In principle, all disease-modifying drugs can have negative effects on fertility or the outcome of pregnancy. For this reason, it is important that certain medications that have been taken over a long period of time are discontinued or the therapy changed at an early stage before trying to become pregnant. The desire to have children and pregnancy should always be discussed with the treating physicians in order to weigh up the risks for the patient and the child and to agree on possible therapy adjustments.Points to be discussed in this context include

• What was the previous activity of the disease?
• Can the previous medication also be taken during pregnancy?
• Has escalation therapy already been necessary beforehand?
• What is the general state of health?

Pregnancy in multiple sclerosis patients is associated with risks for the patient and the unborn child, which should also be taken into account.These risks include

• Effects of MS medication on the unborn child
• Effects of a possible break in therapy on the patient
• Relapse control (even with reduced risk)

‍

‍

Is a natural birth possible?

Yes, if there are no major physical limitations, a natural birth is possible. However, if, for example, there is spasticity, muscle weakness in the legs or fatigue, this can lead to a considerably more strenuous delivery for the affected person. A caesarean section should therefore also be considered in this case.If you decide to have a natural birth, there is no increased risk of pushing due to a possible spinal or epidural anesthesia (epidural).The use of spinal anesthesia or general anesthesia is possible during a caesarean section.However, a home birth is not recommended in the case of pre-existing conditions such as MS. In the event of an unforeseen emergency, mother and child can be better cared for in hospital, as doctors are on site, there is greater access to medication and hygiene is better than at home.

‍

‍

Does breastfeeding have an effect on MS?

Breastfeeding is generally recommended for all mothers, as breastfeeding has many benefits. In particular, breastfeeding promotes the mother-child relationship, provides the child with important antibodies and strengthens the baby's immune system.

Large studies have shown that breastfeeding mothers have a 35% lower risk of a relapse compared to non-breastfeeding mothers. In general, the recommendation to breastfeed also applies to mothers who have MS. As with pregnancy, it is important to pay attention to the therapy and adjust it if necessary.‍

The treating neurologist should be consulted regarding immunomodulatory therapies during pregnancy and breastfeeding. Many immunomodulatory therapies are not suitable during pregnancy and breastfeeding. This means that they can potentially harm the child and should therefore not be taken during this time.

Beta-interferons are approved for use during pregnancy and breastfeeding. They only pass into breast milk to a small extent and so far no negative effects of beta-interferon therapy on pregnancy or the child have been proven.

Low-dose cortisone boost therapy can also be administered during breastfeeding. However, breastfeeding should be discontinued for at least four hours after administration of the preparation. High-dose cortisone must not be administered during breastfeeding. If this therapy has to be used, breastfeeding must be interrupted.

‍

‍