MS, pregnancy and parenthood

Multiple sclerosis is a very variable condition of the central nervous system, with the first symptoms usually occurring in young adulthood. At this time many people are embarking on a career, establishing long- term relationships and deciding to start a family. The diagnosis of a lifelong disease with an unpredictable course can have an impact on all of these issues.
The decision to start or add to a family can be difficult enough for couples without MS, but where one partner has the condition, many questions and concerns may come to mind. Unfortunately, there are countless myths and misconceptions surrounding MS, pregnancy and parenthood, making it difficult for people with MS to obtain clear, accurate information on which to base their choices.
In addition, people with MS frequently encounter negative attitudes to their pregnancies from friends and family, and even from some health care professionals. These negative attitudes usually arise from misconceptions, meaning that the person with MS may find themselves in a position of having to educate others.
There is therefore a great need not only for correct advice and information, but also support from health care professionals such as an MS Nurse, neurologist or GP.

The link between pregnancy and MS

It is now accepted that MS is an autoimmune disease. The immune system is the body’s defence mechanism against infective organisms e.g. bacteria. However, in MS cells from the immune system recognise the myelin sheath (insulating substance which coats nerve fibres) as a foreign “invader”, and co-ordinate an attack. This leads to inflammation, loss of myelin and scarring within the central nervous system, causing the many possible symptoms of MS.
The immune system is known to be under the influence of the endocrine (hormonal) system, hence MS changes may occur as a result of hormone fluctuations in pregnancy. Although the exact reasons for these changes is unknown, the hormone believed to be responsible for altering the immune system is oestrogen. During pregnancy oestrogen levels steadily rise, and are highest during the last three months. This suppresses activity of the immune system, and many women will have less active MS at this time. However, after the birth, oestrogen levels rapidly drop, and the immune system returns to its usual function. Consequently MS activity may resume.

Pregnancy and MS

One of the most frequently asked questions by couples contemplating starting a family is whether MS can be passed onto the baby. Whilst it is known that there is a genetic tendency towards developing MS, it is not a directly inherited condition, and there are many other factors involved. The children of a person with MS have a slightly higher risk of later developing the disease than the general population. However, this is still considered a low risk, and should not discourage a couple from having children.
In the 1940’s and 50’s, women with MS were often advised by their doctor not to have children. This advice was based on mistaken beliefs that pregnancy would make MS worse, and that women would become more disabled and therefore be unable to raise their children effectively. However, a research study in 1950 was the first to provide evidence that childbirth had no long-term detrimental effects on MS . Since then, there have been many extensive studies confirming this, and the advice given to women with MS has thankfully changed.
From these research studies it is clear that for many women with relapsing remitting MS, relapse rate is reduced during late pregnancy because of the effect of pregnancy hormones suppressing the immune system. However, in the first 1-2 months after childbirth women are at much higher risk of relapse, when the hormonal system returns to normal. This increased risk lasts between 6 and 9 months, but when taking the pregnancy and post- natal period overall into account, the effect on relapse rate is considered neutral i.e. neither positive nor negative. One drawback of many of these studies is that few women with progressive MS were included, and hence the results cannot read more