How Women with Multiple Sclerosis Can Navigate Pregnancy

Kim Ramsey

Multiple sclerosis (MS) is a non-communicable disease that affects maternal health. MS is an unpredictable chronic disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. The progress of this disease, its severity, and specific symptoms cannot yet be predicted and varies by individual. Symptoms may disappear or diminish completely, or they may persist and worsen over time. Typical symptoms include fatigue, numbness and tingling, blurred vision, imbalance, pain, and problems with memory and concentration.

This article is part of the Maternal Health Initiative’s CODE BLUE series, developed in partnership with EMD Serono, a business of Merck KGaA, Darmstadt, Germany. Every year, 18 million women of reproductive age die from non-communicable diseases (NCDs) which poses a growing and often overlooked challenge to global maternal health. The CODE BLUE series aims to bring to light and explore these issues.

More Common in Women

Since 1990, the global prevalence of MS has increased 10.4 percent with approximately 2.2 million diagnosed cases in 2016 worldwide. In the United States alone, nearly 1 million people live with MS, according to a recent study funded by the National Multiple Sclerosis Society. The disease is three times more common in women than in men. Therefore, women grapple with unique challenges and unknowns related to women’s health—including, pregnancy, postpartum, and menopause. In addition, MS is often diagnosed as they are building their careers or thinking of starting a family. Given the potential impact MS may have on women’s physical and cognitive faculties, it may affect their ability to work and care for themselves and families.

I’ve personally had the pleasure of working in the MS field for more than eight years. In my professional role, I help connect the pharmaceutical industry and the patient advocacy community. Through my work, I’ve noticed a consistent theme among patient advocates and individuals whose lives are affected by MS, particularly women with MS: family planning and how to care for their families well into the future.

MS and Fertility

Multiple sclerosis does not seem to impair fertility, according to some studies. Those studies suggest that MS has not been shown to have an impact on women’s ability to conceive, carry to term, or on fetal development. More women with MS are becoming pregnant today than even 10 years ago. With careful planning and regular conversations with her doctor, a woman with MS can get pregnant. In fact, recent studies suggest that pregnancy does not seem to affect the long-term prognosis of MS or the overall progression of disability in MS. However, some women report a decrease in MS relapses during pregnancy but relapses tend to increase during the first three months after giving birth. A woman should consider getting a support plan for the first few months following birth and discuss it with her doctor and support network.

Planning Ahead

One of the biggest challenges we hear from women living with MS who are considering pregnancy is how and when to start the conversation with their healthcare team. It is important that women have conversations with their MS healthcare providers, their general practitioners, and OB-GYN. Key questions a woman should bring up with her healthcare team include:

How do I manage my MS care during pregnancy?
How will I manage any relapses before, during or after pregnancy?
What can I do today to address starting a family with MS in the future?

In addition, there are steps to consider improving overall health before pregnancy. All women, regardless of MS diagnosis, are encouraged to get rest, eat a healthy diet, take prenatal vitamins, avoid alcohol and smoking, and follow their doctor’s advice when preparing for pregnancy.

Debunking Common Myths

It is also important we highlight the facts regarding MS and pregnancy:

Pregnancy may be managed safely with the help of your doctor. More women with multiple sclerosis (MS) are becoming pregnant today than even 10 years ago.
MS has not been shown to increase the risk for birth complications such as spontaneous abortions, miscarriages, or birth defects.
Pregnancy does not seem to have a negative impact on the long-term prognosis of MS.
MS is not directly inherited. Most people with MS—as many as 80 percent—do not have a relative with the disease. However, a number of genes have been associated with an increased risk for developing MS. In the general population, any person’s risk for developing M S is 0.13 percent. Having a parent or sibling with MS increases the risk to 2.0 or 2.5 percent. When both parents have MS, the risk of a child developing the disease is increased to at least 30 percent.

Speaking Up

If those in, and those who serve, the MS community continue to drive awareness around pregnancy and MS, challenge the myths, and develop more resources to address key questions, we will improve family planning for MS families around the globe. The important takeaway for those living and caring for someone with MS is that they must use their voices. Women with MS should speak up and ask their health care professionals questions early and often in order to increase the likelihood of navigating pregnancy and multiple sclerosis.

Cardiovascular disease can be a silent killer during pregnancy and beyond.
Mothers’ mental health erodes in Nairobi due to many stressors.
Care for maternal health and non-communicable diseases must be integrated.

Kim Ramsey is Director of Patient Advocacy and Strategic Partnerships at EMD Serono.

Sources: Annals of Physical and Rehabilitation Medicine, Multiple Sclerosis Journal, National Multiple Sclerosis Society, Neurology, Neurology Clinical Practice, Neurotherapeutics, New England Journal of Medicine, The Lancet Neurology, Therapeutic Advances in Neurological Disorders.