Planning pregnancy with MS
Reassuringly, MS does not directly affect fertility, and there is no evidence to suggest that conception will be harder for those with MS.
Some individuals with MS may have additional factors that could indirectly affect their fertility, such as low libido or physical disability. It's therefore important to consider what works best for you and plan accordingly.
Informing the MS specialist team of any plans for pregnancy is key for the safety of both mother and baby, and means that any changes to medication or any additional support needed can be proactively planned.
Disease-modifying drugs (DMD’s) are a crucial part of the discussion, and it's vital that any changes are made only under the direct guidance of the MS specialist team. This could involve: discussing safer alternative DMD’s, stopping medication for a set time before trying to conceive, or gradually withdrawing from current medication to prevent a re-bound relapse, which can occur if a medication is stopped suddenly.
Will I need to change DMD when pregnant?
Not all disease-modifying drugs are safe during pregnancy, and it can be quite confusing to navigate.
Understandably, the thought of stopping or altering a medication regime can be anxiety-inducing as there is a lot to think about, and some women may be using a medication currently that they feel works well for them.
Some of the newer medications have less retrospective data supporting their safety, which means that they simply haven’t been around long enough to have a lot of data from women who have been using them whilst pregnant. For this reason, neurologists may be cautious, but it doesn’t necessarily mean they are dangerous.
Other older DMD’s have more data evidencing their safety during pregnancy, and neurologists may offer them as alternatives to women who are currently pregnant or trying to conceive.
Good practice for individuals with MS hoping to conceive is to have a family planning discussion at least 6 months prior to actively trying for a baby. Any advice needs to be tailored to each individual, to weigh up the risks and benefits of treatment and its potential effects on pregnancy, as well as the risk of MS relapse if there are any periods of no treatment.
Here are some important questions to discuss with the MS specialist team if you are planning to become pregnant:
- Can I continue taking my current DMD?
- Is there a safer alternative?
- How long do I need to stop taking my current medication before I can start trying to conceive?
- Can I stop this medication abruptly, or do I need to reduce it gradually?
- How active is my MS, is relapse a concern?
- Will there be a period of time with no treatment, and if so what safety measures are there?
- What other support would be beneficial for me?
Breastfeeding and MS
Some medications are shown to pass into breast milk, whilst others aren’t. In short, there is no simple answer as it is dependent on each individual case, so it's safest to speak with your MS team about breastfeeding and whether it's safe to do so whilst you are on your current medication.
Some things to consider and discuss with the specialist team could be:
- Is my current medication shown to pass into breast milk?
- Is it safe for my baby if I breastfeed whilst on my current medication? If not, what other options do I have?
- Are there protective factors for the mother from breastfeeding – some studies suggest this
- If I have stopped my medication in order to become pregnant, is there a higher risk that I may have an MS relapse postpartum? If so, will I need to go back to my previous DMD?
Medication for individuals with MS can extend outside DMD’s. They might include medications for symptom management such as painkillers, or medications for acute issues like urinary tract infections.
As with DMD’s, any changes to regular medications should only be implemented under professional guidance. It can be dangerous to stop taking certain medications, so always speak to your MS team before making any changes yourself.
Evidence suggests the risk of relapse is lower during pregnancy by up to 70%. However, should relapse occur, the decision to use steroids should be weighed up by considering the potential benefits and risks. General advice suggests steroid usage is ok, but some people with MS may not wish to use them while pregnant.
- MS does not directly impact fertility
- Do not stop taking or alter any current medication regime unless under direct professional guidance
- DMD’s may need to be altered. It’s important to inform your specialist team if you are trying to conceive or become pregnant
- Proactive family planning is important
- Some guidance can be general, but each case is individual and should receive tailored advice
About the Author:
Victoria Bradley is a Community Nurse Specialist in the Health Inclusion Team – Asylum and Refugee Health at Guys’ & St Thomas NHS Trust in London. She has MS and has been following the Overcoming MS Program since January 2021.