Two neurologists answer questions surrounding family planning, pregnancy, breastfeeding and more.
If you’re a woman diagnosed with multiple sclerosis, you may be wondering how the condition could affect having a child or vice versa. Two neurologists with the Vanderbilt Multiple Sclerosis Center want to dispel myths surrounding family planning, pregnancy and MS to put women at ease.
“I think patients are worried that they shouldn’t have a baby,” said Joy Derwenskus, D.O. “They’re worried about the implications of that.” But she said people with MS can confidently pursue pregnancy and breastfeeding.
“Patients with MS actually do really well during pregnancy,” explained Stephanie Taylor, M.D. “It’s all about communicating closely with their doctors to make sure that they have a good plan.”
Family planning after an MS diagnosis
Although MS does have a genetic component, the risk of a child developing MS because their parent has it is quite low — under 5%.
MS also shouldn’t impact your fertility. “But what we do see, anecdotally,” Taylor said, “is sometimes patients will delay pregnancy because they’re focused on getting their health in good shape.” That could mean some people with MS are older than average when trying to get pregnant and may need fertility assistance, but that’s not related to the disease itself.
If you are thinking about becoming pregnant, Derwenskus and Taylor recommend having a conversation with your doctor. Your provider can assess your disease activity and medications and which ones you may need to discontinue and when.
A plan is unique to each patient and their circumstances. “It’s just very important for people to have a planned pregnancy — as much as possible,” Derwenskus said, “and to do that when their disease has been stable.”
“When medications are abruptly stopped, either to get pregnant or because you’ve become pregnant, there is a slight increased risk of having disease activity at that time,” Taylor added. “So we watch very carefully.”
Pregnancy with MS
MS disease activity and relapse tend to go down during pregnancy. “We actually have some data showing us that women who have children may actually tend to fare better,” Derwenskus said.
Taylor explained that the reason for this is that pregnancy may have a protective effect against MS. “When a woman gets pregnant,” she said, “her immune system actually transitions away from that pro-inflammatory state because it has to protect the fetus.”
However, if you do have MS disease activity while pregnant, rest-assured your doctor can help manage symptoms by treating with steroids if needed, Derwenskus said.
“We just have a close conversation with their OB/GYN,” Taylor added, “to make sure that they think everything will be safe for the baby and the pregnancy.”
Postpartum MS management
The big conversation postpartum is when to restart medications. “This is where breastfeeding comes into play,” Taylor said. “It’s generally recommended that the decision is made to either exclusively breastfeed or to get started on a treatment.”
Breastfeeding may help prolong pregnancy’s protective effects. For patients who are interested in breastfeeding, Taylor and Derwenskus recommend doing so exclusively for three months or longer.
“It’s a discussion between patient and doctor,” Taylor added. “Was the MS really active before pregnancy? Do we need to get you on treatment right away? And how important is breastfeeding? It’s something we can absolutely support. But if someone doesn’t want to breastfeed, which is a valid choice, then we get them right on treatment and get them protected.”
The Multiple Sclerosis Center at Vanderbilt University Medical Center evaluates and treats adults and children with multiple sclerosis and similar conditions.
