Multiple Sclerosis and Pregnancy
What is multiple sclerosis?
MS is a chronic disease of the central nervous system, which is made up of the brain and spinal cord. It’s an unpredictable condition that can be relatively benign to disabling. Some people with MS may be mildly affected, while others may lose their ability to write, speak, or walk when communication between the brain and other parts of the body becomes disrupted.
What causes multiple sclerosis?
There are many possible causes of MS, including viruses, autoimmune disorders, environmental factors, and genetic factors. All of the possible causes share the common feature that the body's immune system is prompted to attack its own nervous tissue. In particular, in MS, the immune system commonly attacks the layer of protein called myelin that surrounds the connecting fibers between parts of the central nervous system. This layer of protein normally provides insulation for the electrical signals that the nervous system uses to communicate. When this insulation is destroyed, communication becomes interrupted and ultimately parts of the nervous system are permanently destroyed.
What are the symptoms of multiple sclerosis?
Symptoms of MS are erratic. They may be mild or severe, and of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected. Throughout the course of the illness, a person may have any or all of the following symptoms, to a varying degree:
Muscle weakness in the extremities
Difficulty with coordination. Impaired walking or standing may result and partial or complete paralysis is possible.
Spasticity. An involuntary increased tone of muscles leading to stiffness and spasms.
Fatigue. This may be triggered by physical activity, but may subside with rest, or may be constant, persistent fatigue.
Loss of sensation, tingling or numbness
Loss of vision or changes in vision
Bowel and bladder dysfunction
Changes in reflexes
Many people with MS have cognitive impairments related to their disease. The effects of these impairments may be mild, often detectable only after comprehensive testing, and may include difficulty with any or all of the following:
The symptoms of multiple sclerosis may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.
How is multiple sclerosis treated?
There is no cure for multiple sclerosis, however there are strategies available to lessen and manage the symptoms, treat flare-ups or relapses, improve your function and safety, and provide much needed emotional support.
There are several FDA-approved medications that can help decrease symptoms, Sometimes flare-ups are treated with steroid therapy. The use of rehabilitation therapies, including physical therapy, occupational therapy, speech and swallowing assistance, cognitive therapy, or the use of assistive devices like splints.
What are the complications of multiple sclerosis?
Since MS is a chronic disease of the central nervous system, it is an unpredictable condition that can be relatively benign, disabling, or devastating. Some individuals with MS may be mildly affected, while others may lose their ability to write, speak, or walk when communication between the brain and other parts of the body becomes disrupted.
Living with multiple sclerosis while pregnant
Fortunately, pregnancy does not appear to speed up the course or worsen the effects of MS. However, it is thought that women who have unrecognized MS may be more likely to begin having symptoms during pregnancy. Some studies have found that MS symptoms decrease in pregnancy and increase after delivery.
The disabling effects of the disease may make it physically difficult for the mother to carry a pregnancy. Muscle weakness and coordination problems may increase the likelihood for falls. Fatigue may worsen. Paralysis and wheelchair dependence may increase the risk for urinary tract infections. There is no evidence that MS causes infertility. Studies have shown that pregnancy, delivery, and congenital abnormalities are not significantly different in women with MS compared with those without MS.
Women in labor with MS may not have pelvic sensation, and may not feel pain with contractions. This may also make it difficult for them to tell when labor begins. Delivery of the baby may be more difficult in women with MS. While labor itself is not affected, the muscles and nerves needed for pushing can be affected. This may make Cesarean section surgery, forceps, and vacuum-assisted deliveries more likely.
Pregnant women with MS need close monitoring of the disease and of fetal well-being. More frequent prenatal visits may be needed. There is no established treatment that alters the course of MS. However, medications may be used in pregnancy including steroids and anti-inflammatory drugs. A procedure called plasmapheresis (a method for removing toxic elements from the blood) has been used in investigative trials for treatment of MS. Consult your doctor for more information.
Supportive treatment and rehabilitation for MS are especially important during pregnancy. Rehabilitation varies depending on the range, expression, severity, and progression of symptoms. MS rehabilitation may help to accomplish the following:
Restore functions that are essential to the activities of daily living (ADLs)
Help the woman to reach maximum independence
Promote family involvement
Empower the woman
Educate the woman regarding the use of assistive devices (for example, canes, braces, and walkers)
Establish an appropriate exercise program that promotes muscle strength, endurance, and control
Re-establish motor skills
Improve communication skills for women who have difficulty speaking because of weakness or lack of coordination of face and tongue muscles
Manage bowel or bladder incontinence
Provide cognitive retraining
Adapt the home environment to emphasize function, safety, accessibility, and mobility
How is multiple sclerosis diagnosed?
Your health care provider will do a thorough medical history and a physical exam as the first steps toward diagnosis of MS. You will be asked about all of your symptoms, as well as the frequency and duration of the symptoms.
An MRI (magnetic resonance imaging) is commonly used to diagnose MS. This test can detect the unique and distinctive lesions or scars in the central nervous system.
If the physical exam, medical history and MRI do not paint a clear picture of MS, there may some lab tests or a lumbar puncture performed next to confirm the diagnosis.
When should I call my health care provider?
You should call the doctor if you have several of the classic symptoms of MS. Waiting is no guarantee that the symptoms will pass. You should begin treatment as soon as possible after diagnosis.
If you have MS and want to become pregnant, it is helpful to discuss the benefits and risks of a pregnancy with your MS specialist before becoming pregnant.
If you are pregnant and having the symptoms of MS, you must communicate this to your doctor as soon as possible.
If you have MS and you are pregnant, let you doctor know as soon as possible.
Although not usually curable, there are many interventions that can help living with multiple sclerosis much more palatable.
With MS, you may have long periods of remission of your symptoms.
Pregnancy is not ruled out just because you have MS.
Tips to help you get the most from a visit to your health care provider:
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.