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Reproductive Information
Effects of MS on Pregnancy
Does having MS alter pregnancy outcome? Is special management warranted during pregnancy for a woman with MS? These questions will be addressed in this section which covers the period during pregnancy and delivery.
Pregnancy Management
Women with MS are not considered “high risk” from an obstetrical point-of-view. Women should be assessed for potential factors related to MS that may necessitate further obstetrical monitoring such as a history of blood clots, function-impairing relapse, cognitive problems or limited mobility hindering ability to push during delivery. Some MS symptoms may be exacerbated by pregnancy and women should be prepared for these possibilities which may include:
- fatigue;
- bladder and bowel concerns (urinary tract infections, incontinence, constipation);
- poor balance which may increase with advancing pregnancy as the centre of gravity shifts and muscles naturally relax in preparation for delivery.
Women with MS are not exempt from common pregnancy complications and referral to Departments of Obstetrics and/or Medical Genetics may be warranted by the presence of multiple fetuses, history of multiple miscarriages, genetic problems in the family other than MS, abnormal screening or diagnostic test results (maternal serum screening, amniocentesis, chorionic villus sampling (CVS), ultrasound), or abnormal fetal positioning).
The relatively high rate of depression among people with MS (lifetime prevalence estimated at 50% ) may contribute to an increased rate of post-partum depression. (See Mood and Cognition for more information)This is a serious and potentially life-threatening condition which should be closely monitored. (Ref : J Obstet Gynecol Neonatal Nurs. 2004 Nov-Dec;33(6):729-38 Postpartum emotional distress in mothers with multiple sclerosis. Gulick EE, Kim S.)
Effects of Pregnancy on MS symptoms
- In general, the clinical course of MS does not change dramatically during pregnancy or after delivery.
- There is a tendency for reduction in the rate of relapse during pregnancy, particularly during the last trimester.
- There is an increased risk of relapse in the first 3-6 months after delivery.
- These above observations are noted as a trend on a population level and do not predict the course for any individual woman with MS.
- Clinical course prior to pregnancy is likely the best predictor of a woman’s clinical course during pregnancy and in the post-partum period.
- Having had a pregnancy does not seem to alter the long term outcome for a woman’s clinical course.
Delivery and Anesthesia
- There is no contraindication to epidural anesthesia use during labour for the woman with MS.
- Caesarian section is not contraindicated in the woman with MS if it is medically warranted.
- Women with MS are at increased risk for fatigue during labour and may need assisted deliveries (vacuum, forceps) more often than women who do not have MS.
Acta Neurol Scand Suppl. 2006;183:51-4. Planned vaginal births in women with multiple sclerosis: delivery and birth outcome. Dahl J, Myhr KM, Daltveit AK, Gilhus NE.
J Neurol. 2008 May;255(5):623-7. Epub 2008 Feb 19 Pregnancy, delivery and birth outcome in different stages of maternal multiple sclerosis.Dahl J, Myhr KM, Daltveit AK, Gilhus NE.
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
Eur J Obstet Gynecol Reprod Biol. 2004 Jul 15;115(1):3-9Multiple sclerosis: management issues during pregnancy.Ferrero S, Pretta S, Ragni N.
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