More than 60% of MS patients are diagnosed with the disease in their thirties — in a phase of life in which child planning has often not yet been completed.
Since every course of MS is individual and therapies often have to be adjusted, the desire to have children should be discussed together with the gynecologist and also a neurologist.

In this article, we answer the most common questions about fertility and pregnancy in multiple sclerosis.

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Can you have children with MS?

Yes Multiple sclerosis has no direct effect on fertility in either women or men. Pregnancy and childbirth are also complication-free for most MS patients. A pregnancy with multiple sclerosis is not a high-risk pregnancy per se.
As with any pregnancy, complications can of course still occur. In particular, the complication rate and relapse rate depend on the course of MS and the immunomodulatory drugs. Some medications are contraindicated during pregnancy and should therefore not be taken.
After the birth of the child, the risk of relapse is often temporarily increased, but returns to normal levels. The long-term course of MS is usually not affected by pregnancy.

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Is MS hereditary?

No In principle, according to the current state of science, MS is not a genetically hereditary disease. Nonetheless, there are genetic factors that are associated with MS disease. The risk for children of MS patients of developing MS themselves is 2% higher than for children of non-MS parents. If both parents have multiple sclerosis, the risk rises to up to 20%.

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Is the risk of relapse increased during pregnancy?

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

However, there is a slightly increased risk of relapse in the first three months after delivery, which then returns to normal. 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 relapse.

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Does breastfeeding affect MS?

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

Large studies have shown that nursing mothers have an approximately 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 only important to pay attention to the therapy and adjust it if necessary.

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For immunomodulatory therapies during pregnancy and breastfeeding, the treating neurologist should be consulted. Many immunomodulatory therapies are not appropriate 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 enter 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 relapse therapy can also be carried out during breast-feeding. However, breast-feeding should not be carried out for at least four hours after administration of the preparation. High-dose cortisone should not be administered during breast-feeding. If it is necessary to use this therapy, then breastfeeding must be interrupted.

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Can MS medications 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 to discontinue certain medications that have been taken over a long period of time, to become pregnant early before the start of the attempt, or to change the therapy. The desire to have children and pregnancy should always be discussed with the treatment provider in order to weigh up the risks for the patient and the child and to coordinate possible treatment adjustments.

Points that will be discussed in this context include:

• What was the activity of the disease so far?
• Can the previous medication also be taken during pregnancy?
• Was escalation therapy necessary in advance?
• What is the general health status?

Pregnancy involves risks for the patient and the unborn child in multiple sclerosis patients, which should also be considered.

These risks include:

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

Is a natural birth possible?

Yes If there are no major physical limitations, natural childbirth is possible. However, should spasticity, leg muscle weakness or fatigue occur, this can result in a significantly more strenuous delivery for the person concerned. Therefore, a caesarean section should also be considered in this case.

If you opt for a natural birth, there is no increased risk of relapse due to a possible spinal or peridual anesthesia (PDA).
Spinal or general anesthesia can be used during a caesarean section.

However, home birth is not recommended for pre-existing conditions such as MS. Should an unforeseen emergency occur, mother and child can receive better care in hospital because doctors are on site, there is wider access to medicines and hygiene is also better than in their own homes.

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