|
Reproductive Information
MS after Pregnancy
Pregnancy Outcome
The overall rate of adverse pregnancy outcome is not raised when the mother has MS. That is to say, the chance that the pregnancy will end in miscarriage, stillbirth, premature delivery or the birth of an infant with congenital malformations/birth defects is not different from the risk for any of these outcomes to affect age and ethnicity-matched populations.
There may be a higher proportion of neonates born small for gestational age to mothers with MS but this does not appear to affect survival and development. (Ref : Neurology. 2005 Dec 27;65(12):1961-3. Pregnancy, delivery, and birth outcome in women with multiple sclerosis.Dahl J, Myhr KM, Daltveit AK, Hoff JM, Gilhus NE
When one parent has MS and there are no other affected relatives, there is a 3-5% chance that a child will develop MS during his or her lifetime (See the Recurrence Risk section for more information)
Pediatric onset of MS is rare. This means that for most mothers with MS, their children are not at risk of developing MS until the third or fourth decade of life. Hope for MS treatment and prevention in the future should be emphasized.
The MS recurrence risks quoted are over and above the 3-5% chance that any couple in the general population will have a child with some type of birth defect or developmental deficit unrelated to MS.
All women, regardless of whether they have MS or not, are at risk for post-partum complications and should be monitored with postnatal follow up to assess for post-partum depression, infections, mastitis, and other perinatal complications.
Breastfeeding
Although breastfeeding is a well-recognized benefit to a newborn, it is not feasible for all women to breastfeed their infants. Due to the overwhelming fatigue of nursing every 2-3 hours, some women with MS may choose to use a combination of breast feeding and bottle feeding of formula or expressed breast milk so that their partner or another caregiver can help with night-time feedings. Should a woman make an informed decision not to breastfeed her infant, her decision should be supported by her health care provider.
Many medications are known to cross into breast milk. Any medication being taken by the new mother should be assessed for safety during nursing by her physician.
Some women choose not to breastfeed so that they can safely resume use of disease modifying therapies, thereby decreasing the amount of time they are off medication. Regular medications can be resumed once the baby is weaned.
Discussion with a pediatrician or treating physician about supplemental vitamin D for the baby is suggested. Solely breastfed babies should be given daily 400IU vitamin D supplements at home as recommended by Health Canada guidelines. This supplementation may be especially important in families where MS is present according to recent studies linking vitamin D depletion to MS risk.
There is no reliable or replicated data that breastfeeding is either beneficial or harmful to the maternal clinical course of MS.
Recent data from a small study suggests the possibility that breastfeeding may offer more protection against relapses of MS than the disease modulating therapies.
|
