How Pregnancy Affects Multiple Sclerosis (MS), According to Experts
Multiple sclerosis (MS) can affect anyone at any time. Women, however, are four times more likely to be diagnosed with MS than men; and the onset of MS is most often between the ages of 20 to 40 – prime childbearing years. This may cause many women with the disease to wonder: Will I be able to have children?
“Most of the time, the answer is yes, if they choose to," Andrew D. Smith III, M.D., assistant professor at the Geisel School of Medicine at Dartmouth College and a neurologist specializing in MS with the Multiple Sclerosis Center of the department of neurology at Dartmouth Health. Having a baby if you have MS does take some extra thought, however. “I ask all the women that I care for about their pregnancy plans, as this has an impact on MS disease-modifying therapies,” says Smith.
"Basically, your doctors can design a plan to minimize your risk of attack – this will be based on how well-controlled your attacks were before you got pregnant," explains Ben Thrower, M.D., senior medical advisor for the Multiple Sclerosis Foundation and medical director of the Andrew C. Carlos MS Institute at Shepherd Center in Atlanta, Georgia. With the proper treatment, you can thrive. “Keep the same goals and plans for yourself that you had before your diagnosis,” urges Julie Fiol, MSW, BSN, RN, MSCN, associate vice president of healthcare access for the National MS Society.
Here, these three experts explain how MS is different for women and what you need to have the healthiest, happiest life and, if you choose to get pregnant.
Why is MS more common in women?
Women are four times more likely to develop MS than men. Hormones could be a key reason. “There have been suspicions for some time that they play a role in someone developing MS,” says Fiol. “Hormones could be at play but are likely not acting alone. Still, there are many times in a woman’s life when the effects of MS change, and hormonal changes are also at play during those times. For example, we don’t see differences in the number of boys and girls diagnosed with MS until after puberty, where the number of girls becomes higher than the number of boys.”
Menstrual changes may also play a part for women already diagnosed. “Some women report a mild increase in MS symptoms around the time of their period,” says Thrower. “Menopause does not appear to have a significant effect on MS overall, however.” What about birth control pills? For now, using them appears to have no impact, in terms of risk or worsening of MS symptoms. “In general, women with MS can use oral contraceptives and/or post-menopausal hormone replacement in the same ways that women without MS can,” Thrower adds.
Another possibility is that a woman’s body type could heighten susceptibility to the condition. According to data from Johns Hopkins Medicine, the inflammation that is tied to obesity could be a link to MS. Women also tend to carry more fat in their abdomen area than men do, which is an especially big risk factor for the development of inflammation.
Do women experience different MS symptoms?
“In general, women and men can experience the same symptoms of MS.” explains Fiol.“However, the course of MS can be different for men than for women. Women tend to have more relapses and have an earlier onset of the disease than men. Men tend to have a more progressive course of MS, accumulating disability faster. Men also tend to experience more cognitive impairment than women.”
As a whole, the symptoms of MS can vary from person to person, regardless of gender. According to the Mayo Clinic, symptoms of the disease include:
Numbness or weakness in your limbs, which could be on one side of your body
"Electrical shock” sensations if you move your neck forward
Tremors
Vision loss, blurry vision or double vision
Slurring of your speech
Fatigue
Tingling feelings, or aches and pains
Problems with sexual, bowel, or bladder function
How is MS diagnosed and treated?
If your doctor suspects you might have MS, diagnosis can take some time. According to Cleveland Clinic, blood tests can be used to rule out conditions that can mimic MS, like a vitamin B-12 deficiency or rarely, lupus. Then, an MRI of the brain can show lesions or changes that are indicative of MS. Sometimes, a spinal tap is given too, and the fluid is analyzed for signs of MS.
Treatment usually means that a patient will work with a team of doctors, to receive the most comprehensive care possible. Medications, rehabilitation and complementary and/or alternative treatments are all possibilities your team may recommend. MS treatment is highly individual to each patient, so treatment will be carefully tailored to your needs.
How does pregnancy affect MS?
"Pregnancy actually has a calming effect on MS," says Thrower. "Your immune system has learned to tolerate a foreign body already – your MS – and so carrying a baby is not difficult for your body to adapt to." A study from Norwegian researchers found that there is approximately a 70% decrease in relapse of MS symptoms during the third trimester of a woman’s pregnancy.
This is in part due to a specific type of estrogen associated with pregnancy, estriol, which appears to keep MS in check — it's even used as an MS therapy. “Levels of an estriol spike during pregnancy,” explains Thrower. “This hormone appears to have a protective effect, resulting in a lower risk of MS relapses and new lesions on MRIs.”
“Some of the medications we use to treat MS are contraindicated in terms of pregnancy and breastfeeding," advises Smith. "However, most women do not require treatment during pregnancy, because of how the risk of relapse significantly decreases.”
“Six months following childbirth, there is the risk of relapse, but we also know that breastfeeding can extend the protective effects of pregnancy,” adds Thrower.
Bottom line:
“Most women do not have any significant issues with childbirth,” says Smith. “However, women who have more significant neurological disability may have higher risk with childbirth. They should be followed by a maternal-fetal medicine (MFM) obstetrician due to this increased risk. Still, it’s extremely uncommon for women to be counseled against becoming pregnant.”
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