Approximately three times as many women as men have MS. Most women are diagnosed in their mid thirties at exactly the time when they may be thinking about starting a family. The issue of pregnancy and MS is therefore an important one. In addition, women who have been diagnosed with MS may have concerns about how the disease will affect their ability to have children and how pregnancy and delivery may exacerbate their MS.
The major factors in the decision to have children are the same for people with MS as they are for other people. The decision whether to have a family and when to start is a very personal one and needs to be made with attention to current and future emotional, financial and medical considerations.
Although we still do not understand what causes MS, research suggests that there is a genetic component in a person’s susceptibility to developing the disease. Children who have a parent with MS have an approximate 3% (3 out of 100) chance of developing MS themselves. The risk in the general population is approximately 0.3% (that is, 3 children out of 1000 will get MS). So although having a parent with MS increases the risk, it is important to remember that the risk remains quite small.
While MS does not affect a woman’s fertility, men who experience MS related problems with ejaculation may need medical intervention to assist with fertility. Since the majority of couples will not experience any reduction in fertility, you will be faced with the same decisions about birth control as any other couple. You are free to use any form of birth control that you find manageable and comfortable. However, keep in mind that some forms of contraception require more manual dexterity than others. Also, a diaphragm may increase a woman’s risk of bladder infections. Because of these concerns, you may want to consider using additional birth control protection with any one of these methods. It is important to consult your general practitioner (GP) when you and your partner are deciding on the most suitable form of contraception.
Couples do not need to be concerned that a woman’s MS will affect her ability to have a normal, healthy baby. MS has not been found to affect the course of pregnancy and labour. Neither does it increase the risk of miscarriages, complications during labour or delivery, foetal malformations or stillbirths. Epidural anaesthesia is considered safe to use for pain relief during labour and has been found to be beneficial for women who experience spasticity. Either general or epidural anaesthesia is recommended for women requiring caesarean section.
As a general rule, the use of any medications during pregnancy and breast-feeding (including ones bought over-the-counter) should be done cautiously and under the supervision of your GP. If at all possible, a woman who wishes to become pregnant should consult her GP prior to conception about any medications she may be taking. The GP will eliminate any unnecessary medications and substitute safer ones where required. Both men and women taking Disease Modifying Treatments who wishes to start a family should review treatment options with their neurologist or GP. A woman who becomes pregnant while taking any medications should review them with her doctor as soon as possible. Similarly, men may also need to cease use of these treatments to assist spermatogenesis (sperm production) and should seek the advice of their treating doctor.
Any mother who wishes to breast-feed is encouraged to do so, provided she has the strength to do it safely and does not require any medications that might be unsafe for the baby. It is recommended that women talk to their neurologist and GP about the best time to recommence their MS medications. Since fatigue can sometimes affect milk production, it is important for the new mother to eat well, get plenty of rest and have sufficient help available in the home.
Before 1950, women with MS were routinely advised by their doctors not to have children. All of the published research since has pointed to a very different conclusion. A woman’s MS is likely to be stable, or even improved, during the nine months of pregnancy. In the few months following the pregnancy (whether the pregnancy goes to term or ends prematurely), the risk of exacerbation has been found to range from 20% to 75%.
Research suggests that a possible indicator might be related to the frequency of exacerbations experienced by the woman prior to the pregnancy. Given the increased chance of an exacerbation, it may be beneficial to arrange for some additional short-term assistance in the home. This support may include help from family and friends. Community Support Staff from the MS Society in your region can also provide information on services available in the community. Researchers have also concluded that pregnancy does not affect the woman’s long-term disease course or level of disability. This means that a woman can make her decision knowing that becoming pregnant is unlikely to have any long-lasting impact on the course of her MS.