Yes, you absolutely can get pregnant with Multiple Sclerosis. Multiple Sclerosis (MS) is a chronic autoimmune condition that targets the central nervous system, causing inflammation and damage to the protective myelin sheath around nerve fibers. This diagnosis does not change a woman’s ability to conceive a child. Family planning is a manageable part of life for women with MS, provided it is approached with careful medical guidance and pre-planning.
Understanding Fertility and Pre-Pregnancy Consultation
Multiple Sclerosis itself generally does not impair a woman’s fertility rate, meaning the likelihood of conception is comparable to that of the general population. While MS does not affect the reproductive organs, MS does not increase the risk of miscarriage, stillbirth, or congenital malformation in the child.
The most important step for anyone with MS considering pregnancy is a pre-pregnancy consultation (PPC). This consultation involves the neurologist and ideally an obstetrician, to create a structured plan for the pregnancy and the period leading up to conception. This planning is necessary primarily to manage the MS medication regimen. If a woman is off her MS medication while trying to conceive, a fertility specialist may be seen after six months instead of the typical 12 months for the general population.
MS Disease Activity During and After Pregnancy
Pregnancy has a distinct and generally beneficial effect on MS disease activity due to hormonal changes. The relapse rate for women with relapsing-remitting MS often decreases, particularly during the later stages of pregnancy. Research shows that the annualized relapse rate can fall significantly, with the greatest reduction often occurring in the third trimester.
This protective effect is related to the high levels of specific hormones, such as estrogens and progesterone, which modulate the immune system during pregnancy. This natural shift makes the immune system less aggressive, leading to a decrease in the inflammation characteristic of MS. Disability progression does not appear to change significantly over the long term following a pregnancy.
The protective effect of pregnancy ends immediately after delivery, leading to a period of heightened risk. The postpartum period, especially the first three to six months, is associated with an increased risk of relapse, often returning to the pre-pregnancy rate. Exclusive breastfeeding for a period of at least two to four months has been associated with a lower risk of a postpartum relapse for some women.
Navigating MS Medication Management
Managing Disease-Modifying Therapies (DMTs) is a central consideration when planning a pregnancy with MS. Most DMTs carry warnings against use during conception, pregnancy, or breastfeeding because they have not been proven safe for the developing fetus. Therefore, a major part of the pre-pregnancy plan is determining when and how to discontinue the current treatment.
Washout Periods
This discontinuation requires a “washout period,” which is the necessary time for the drug to clear the body before trying to conceive. The length of this washout period varies significantly depending on the drug’s mechanism and half-life. For example, some high-efficacy oral medications like fingolimod or dimethyl fumarate may require a two-month washout period.
Other drugs, such as teriflunomide, require a rapid elimination procedure to remove the drug from the body, followed by confirmation of low drug levels before conception is safe. High-efficacy infusion therapies, such as alemtuzumab, require a much longer washout period, potentially up to 16 months from the initiation of the treatment course. A few DMTs, like certain interferon-beta injections and glatiramer acetate, have the most evidence to support continuation into the early stages of pregnancy, and sometimes throughout, based on extensive safety data.
Postpartum Treatment Decisions
The decision to restart DMTs immediately after delivery is a shared one between the patient and the neurologist, balancing the high postpartum relapse risk against the desire to breastfeed. Women who do not plan to breastfeed often resume their DMT immediately after giving birth to mitigate the relapse risk. Those who wish to breastfeed may delay restarting treatment, as some studies suggest exclusive breastfeeding offers a protective effect against early postpartum relapses.
Delivery Logistics and Infant Health Considerations
The presence of MS typically does not necessitate a Cesarean section (C-section); the mode of delivery is usually determined by standard obstetric indications. MS does not prevent the use of common pain relief options during labor. Epidural analgesia is considered safe for women with MS and has not been correlated with an increased risk of postpartum relapse or disability progression.
While MS is not directly passed from parent to child, having a parent with MS slightly increases the genetic predisposition. The lifetime risk of a child developing MS when one parent has it is estimated to be low, typically cited in the range of 1.5% to 3%. Genetics are only one factor in the complex development of the condition.