Quite often, couples struggle with the decision to have children when the woman has multiple sclerosis (MS). It happened to us; my wife has MS. I’m not a doctor; I’m a researcher and I’m an expert in caring for my wife. I compiled information that was very helpful for us in our journey to have children. There are plenty of websites and opinions on how to approach pregnancy when you have MS. That is not my goal here. Rather, my wife asked that I share the research I spent so many hours to hunt down in case others find it useful. I only use (and welcome more) evidence from peer reviewed medical journals.
Do babies / children increase MS risk?
No. Children may decrease MS risk.
Among women, risk of MS diagnosis was cut in half for each of the first four children born [1]. Females with at least one pregnancy had lower EDSS scores over 10 years [6]. There is a significantly decreased risk of a progressive course in women who were pregnant after multiple sclerosis onset [11].
Does mother’s MS create complications for child?
No. Children of mothers with MS have largely the same risk as other children.
Most women with MS can safely choose to become pregnant, give birth, and breastfeed children [13]. There does not appear to be a major increase in adverse outcomes in newborns of mothers with MS [13]. Mother and baby are relatively safe [14].
Does pregnancy increase MS risk?
No. MS risk is decreased during pregnancy, increased for 3 months after birth, and decreased overall.
Compared with the pre‐pregnancy year, relapse rate is lower during pregnancy (especially during the third trimester), and increased during the 3 months after delivery [2]. Overall relapse rates don’t significantly change in the first two years from becoming pregnant compared to the year before pregnancy [2]. 72% of women did not experience any relapse during those two years [2].
Does cesarean or epidural during birth increase MS risk?
No. Neither cesarean nor epidural show any effect on MS.
Epidural shows no effect on relapse rates [2]. Neither cesarean delivery, nor epidural analgesia are associated with higher relapse rates or disease progression [7].
Does breastfeeding increase MS risk?
No. Exclusively breastfeeding greatly improves the mother’s MS risk if done for a minimum of 2 months, and preferably 6 months or longer.
Women with MS who did not breastfeed or began regular supplemental feedings (of formula) within 2 months postpartum, 87% had a postpartum relapse, compared with 36% of the women with MS who breastfed exclusively for at least 2 months postpartum [3]. However, the protective effect may only emerge after 4 months of exclusive breastfeeding [4]. Findings suggest that breastfeeding is protective against postpartum relapses in MS [5]. Generally, health organizations recommend at least 6 months of exclusive breastfeeding and continued breastfeeding for at least the first year [12].
For baby, breastfeeding decreases the incidence and/or severity of a wide range of infectious diseases [12]. Infant mortality rates in the United States are reduced by 21% in breastfed infants [12]. Breastfeeding reduces the incidence of diabetes, lymphoma, leukemia, and Hodgkin disease, overweight and obesity, and asthma [12]. Breastfeeding has been associated with enhanced performance on tests of cognitive development / intelligence quotient (IQ) [12].
Mother benefits include decreased postpartum bleeding, earlier return to pre-pregnancy weight, decreased risk of breast cancer, decreased risk of ovarian cancer, and possibly decreased risk of hip fractures and osteoporosis in the postmenopausal period [12].
Are steroids safe for baby during pregnancy / breastfeeding if mother needs it?
Probably. If required, scheduling an IV away from breastfeeding time may help.
A study of one mother showed baby received approximately 1% of mother’s dose during breastfeeding [9]. With that mother receiving 1000mg/day, this was considered a tolerable dose for baby compared to other infants requiring methylprednisolone drug therapy [9]. Based on this limited data, it would seem reasonable to continue breastfeeding while receiving a short course of high-dose methylprednisolone [8]. If the mother wishes to further limit infant exposure, she should interrupt breastfeeding for 8–12 hours after high intravenous doses [8].
Are MS drugs safe for baby during pregnancy / breastfeeding if mother needs it?
Depends. Some MS drugs are known to cause birth defects. Others are not.
Should be needless to say: talk to your doctor.
Possibly hazardous: Mitoxantrone, Fingolimod, Dalfampridine, Dimethyl fumarate, Alemtuzumab, Teriflunomide, Cladribine, Rituximab, Daclizumab, Cyclophosphamide, Methotrexate [8]. Fingolimod and teriflunomide are likely associated with an increased risk of fetus malformations and should be discontinued prior to conception [14].
Possibly safe (limited data): Interferons b1a and b1b, Glatiramer acetate, Natalizumab, Baclofen, Methylprednisolone, Azathioprine [8].
Are OTC drugs and prescriptions safe for baby during pregnancy / breastfeeding if mother needs it?
Depends. Read the labels and ask your neurologist and pharmacist.
One potential starting point is this linked resource which shows how individual drugs affect mothers with rheumatic diseases [10].
What do you think?
I’d love to hear if you found this information helpful!
Citations
- “Offspring number, pregnancy, and risk of a first clinical demyelinating event — Neurology.” March 20, 2012. doi:10.1212/WNL.0b013e31824c4648 https://n.neurology.org/content/78/12/867
- “Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post‐partum relapse — Brain A Journal Of Neurology” June 2004. doi:10.1093/brain/awh152 https://academic.oup.com/brain/article/127/6/1353/271792
- “Exclusive Breastfeeding and the Risk of Postpartum Relapses in Women With Multiple Sclerosis — JAMA Neurology” July 2000. doi:10.1001/archneurol.2009.132 https://jamanetwork.com/journals/jamaneurology/fullarticle/797821
- “Breastfeeding is associated with lower risk for multiple sclerosis — Multiple Sclerosis Journal” April 2013. doi:10.1177/1352458512459683 https://journals.sagepub.com/doi/10.1177/1352458512459683
- “Association Between Breastfeeding and Postpartum Multiple Sclerosis Relapses. A Systematic Review and Meta-analysis — JAMA Neurology” December 9, 2019. doi:10.1001/jamaneurol.2019.4173 https://jamanetwork.com/journals/jamaneurology/fullarticle/2756404
- “Sex effects across the lifespan in women with multiple sclerosis —
Therapeutic Advances in Neurological Disorders” July 1, 2020. doi:10.1177/1756286420936166 https://journals.sagepub.com/doi/10.1177/1756286420936166 - “Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study — BMC Neurology” December 31, 2012. doi:10.1186/1471–2377–12–165 https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-12-165
- “Management of Multiple Sclerosis in the Breastfeeding Mother — Multiple Sclerosis International” February 4, 2016. doi:10.1155/2016/6527458 https://www.hindawi.com/journals/msi/2016/6527458/
- “Transfer of Methylprednisolone into Breast Milk in a Mother with Multiple Sclerosis — Journal of Human Lactation” February 17, 2015. doi:10.1177/0890334415570970 https://journals.sagepub.com/doi/10.1177/0890334415570970
- “Medications in pregnancy and breastfeeding — Best Practice & Research Clinical Obstetrics & Gynaecology” April 2020. doi:10.1016/j.bpobgyn.2019.10.007 https://www.sciencedirect.com/science/article/pii/S1521693419301646
- “Pregnancy is associated with a lower risk of onset and a better prognosis in multiple sclerosis — Brain A Journal Of Neurology” February 1995. doi:10.1093/brain/118.1.253 https://academic.oup.com/brain/article-abstract/118/1/253/342031
- “Breastfeeding and the Use of Human Milk — Pediatrics” February 2005. doi:10.1542/peds.2004–2491 https://pediatrics.aappublications.org/content/115/2/496
- “Management of Multiple Sclerosis During Pregnancy and the Reproductive Years — Obstetrics & Gynecology” December 2014. doi: 10.1097/AOG.0000000000000541 https://journals.lww.com/greenjournal/Abstract/2014/12000/Management_of_Multiple_Sclerosis_During_Pregnancy.13.aspx
- “Fertility, Pregnancy and Childbirth in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs — CNS Drugs” March 14, 2015. doi:10.1007/s40263–015–0238-y https://link.springer.com/article/10.1007/s40263-015-0238-y
