MS and pregnancy – part 2

Pregnancy is an exciting time, but it can also be an uncertain one, due to the physical and emotional changes it brings. If you have multiple sclerosis, you’re likely to have a few added concerns about the next nine months. You may be wondering how having MS may impact pregnancy… but it’s also important to understand how pregnancy may impact MS.

To get the facts, we spoke to Dr Magnhild Sandberg-Wollheim, associate professor of neurology at Lund University Hospital in Sweden, and an expert on pregnancy in MS. Here we’ll look at the ways in which pregnancy may impact MS. In the first part of this series, we explored the potential impact of MS on pregnancy.

Will hormonal changes affect my MS?

Yes, probably – but not in the way you would expect. “In the past, there was a fear that pregnancy could bring on relapses in women with MS,” explains Dr Sandberg, “but now we know the opposite is generally true. Many women find their relapse rate reduced during pregnancy, particularly during the last 12 weeks. ” In fact, one study found relapse rate dropped by as much as 70% during the third trimester¹. “This can be partly explained by the increased levels of the pregnancy hormone oestrogen which has a dampening effect on the immune system². ”

Will I face more physical challenges?

Fatigue is common during most pregnancies – thanks to the added nutritional demands and growing weight of the baby – so if you already suffer from low energy levels, you may feel extra tired. Most women find their sleep is interrupted during pregnancy, so again this may impact levels of fatigue. “Existing back and bladder problems can be exacerbated by pregnancy, as the growing baby puts pressure on your skeleton and bladder,” says Dr Sandberg. Mobility can also be more of a challenge. “If you already have issues with walking, then the extra weight of the baby may add to the problem.” Whatever the symptoms, speak to your doctor, physiotherapist or midwife if you are concerned. “Rest assured, any pregnancy-related issues are likely to resolve once your baby is born and your body returns to its pre-pregnancy state,” Dr Sandberg adds.

What can I expect after labor?

“Research shows that the risk of relapse is slightly increased in the first months after giving birth,” explains Dr Sandberg, “But actually only around a third of women experience a relapse during this time, and relapse rate returns to ‘normal’ after six to nine months.¹” Either way, the first year after labor can be a challenging time for all mothers, so it is important to stay in close contact with your healthcare team during this time and report any changes to your neurologist.

Will having a baby affect my MS in the long term?

There could be some good news here. “Although there is conflicting evidence³, some studies suggest having children may have a beneficial effect on MS in the long run^{4, 5},” says Dr Sandberg. One small study, for example, found women who had pregnancies after they had been diagnosed with MS had a lower relapse rate up to 10 years later, compared with women who did not have pregnancies after their diagnosis⁶. Meanwhile, a Swedish study found women with MS who became pregnant after diagnosis had a significantly reduced risk of conversion to secondary progressive MS compared with women who didn’t⁷. “We do not know exactly why pregnancy might slow disease progression in the long term,” says Dr Sandberg, “but it is likely that the sex hormones secreted during pregnancy alter the immune response in some way.”

That is not to say that having as many babies as possible is the answer to treating MS. “Pregnancy, childbirth and parenting all place added demands on the body, so it is important to factor in these considerations if you are thinking about starting a family,” cautions Dr Sandberg. “If you are already expecting, your healthcare team should be working with you to ensure that your pregnancy goes as smoothly as possible. Listen to your body and don’t be afraid to make extra allowances for yourself.” You might want to bank plenty of sleep while you can, too…

We would like to thank Dr Sandberg-Wollheim very much for her time and expert advice.

References:

1. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. N Engl J Med. 1998 Jul 30;339(5):285-91. http://www.ncbi.nlm.nih.gov/pubmed/9682040 http://www.nejm.org/doi/full/10.1056/NEJM199807303390501
2. Immune modulation in multiple sclerosis patients treated with the pregnancy hormone estriol.  Soldan SS, Alvarez Retuerto AI, Sicotte NL, Voskuhl RR. J Immunol. 2003 Dec 1;171(11):6267-74. http://www.ncbi.nlm.nih.gov/pubmed/14634144
3. Does pregnancy alter the long-term course of multiple sclerosis? Karp I, Manganas A, Sylvestre MP, Ho A, Roger E, Duquette P. Ann Epidemiol. 2014 Jul;24(7):504-8.e2. http://www.ncbi.nlm.nih.gov/pubmed/24935463
4. Pregnancy and multiple sclerosis: the influence on long term disability. Verdru P, Theys P, D'Hooghe MB, Carton H. Clin Neurol Neurosurg. 1994 Feb;96(1):38-41. http://www.ncbi.nlm.nih.gov/pubmed/?term=8187380
5. Pregnancy and multiple sclerosis. Damek DM, Shuster EA. Mayo Clin Proc. 1997 Oct;72(10):977-89. http://www.ncbi.nlm.nih.gov/pubmed/?term=9379704
6. Pregnancy and multiple sclerosis: a longitudinal study of 125 remittent patients. Roullet E, Verdier-Taillefer MH, Amarenco P, Gharbi G, Alperovitch A, Marteau R. J Neurol Neurosurg Psychiatry. 1993 Oct;56(10) 1062-5. http://www.ncbi.nlm.nih.gov/pubmed/?term=8410003
7. Pregnancy is associated with a lower risk of onset and a better prognosis in multiple sclerosis. Runmarker B, Andersen O. Brain. 1995 Feb;118 ( Pt 1):253-61. http://www.ncbi.nlm.nih.gov/pubmed/?term=7895009