MS often affects young women, so the topic of pregnancy is interesting in many ways. One might think that many basic things are clear and one is primarily confronted with very specific questions. Surprisingly, however, there is still quite a lot of misinformation and untruths being spread that unjustly unsettle many young couples. MS does not affect fertility – so as an MS patient, you can have offspring just as easily, quickly, unexpectedly as anyone else. The question of whether or not a patient with a chronic illness wants to have children is a very personal matter – at most, a doctor can provide advisory support. However, if a patient (with her partner) has actively and consciously decided for a family, then it is the doctor’s job to support this desire and accompany it positively, i.e. to reduce fears and doubts.
Pregnancy and MS influence each other – but in no case does pregnancy pose a danger to MS patients. Basically, pregnancy, especially in the 2nd and 3rd trimesters, leads to increased tolerance of the immune system. This means that pregnant women are usually protected from MS relapses and inflammatory activity. This protection is lost after delivery and the associated hormonal changes, so that women have a statistically higher risk of suffering a relapse in the first months after delivery. On balance, the reduced risk during pregnancy offsets the increased risk after delivery, so that overall, no increased relapse risk is caused by pregnancy, and six months after delivery, the “normal” relapse risk is reached again.
In the case of moderate MS, all MS medications can therefore be discontinued during pregnancy. It is also not necessary to carry out a prophylactic measure after delivery – even if you occasionally find the recommendation of immunoglobulins peripartum in older texts. The best approach is to let the situation come and also – if desired – to plan to breastfeed your child (fully). If a relapse should occur after delivery, this relapse can be treated with a cortisone pulse. On the other hand, it is not necessarily the case that a relapse will occur in every case – the risk is around 20%, and this risk is driven by women with (highly) active MS. Therefore, slightly different recommendations apply to this group of women than to women with a “normal” course of disease. I will go into this in a separate text.
The question may now arise as to which group (moderate vs. active) one can now count oneself. The simplest distinction is usually that women with highly active disease are typically treated with escalation therapy (e.g. Natalizumab). For women who are treated with a first-line therapy (interferons, glatiramer acetate, fumaric acid, teriflunomide), the above recommendations apply. It is probably worthwhile to plan the delivery in a clinic where neurological expertise is available and thus one is not an exotic as an MS patient. Because sometimes one comes across strange rumors – such as that as an MS patient one cannot get an epidural and can only deliver by caesarean section. This is of course not the case and therefore neurological expertise on site is useful, where the other disciplines such as gynaecology or anaesthesia can reassure themselves. As already mentioned, the desire to breastfeed is also not a problem – on the contrary, there are even data showing that breastfeeding is protective. Therefore, from the point of view of MS, there is nothing to prevent breastfeeding your child for about 6 months. After that, one should resume the prophylactic therapy of MS. Usually, one will continue with the preparation with which one has already gained experience before pregnancy. In addition to the therapy, the monitoring with regular MRI should also be resumed.
