Pregnancy Complications Only Slightly More in Multiple Sclerosis in Womens
pregnant women with multiple sclerosis are only slightly more likely to have cesarean deliveries and babies with a poor prenatal growth rate than women who do not have multiple sclerosis.
Women with multiple sclerosis were also no more likely to have other pregnancy problems, such as preeclampsia and other high blood pressure problems and premature rupture of membranes, than women in the general population.
The large study used a national database from all non-federal short-stay hospitals in 38 states. The data included an estimated 18.8 million deliveries, with about 10,000 of those occurring in women with multiple sclerosis.
The women with multiple sclerosis were more likely than women without chronic medical conditions (2.7 percent for women with multiple sclerosis compared to 1.9 percent for women without chronic medical conditions) to have a fetus with intrauterine growth restriction, defined as a weight less than the tenth percentile for the gestational age, as measured by ultrasound. Women with multiple sclerosis were more likely to have a cesarean delivery than those in the general population (42 percent versus 33 percent).
“These results are reassuring for women with multiple sclerosis,” said study author Eliza Chakravarty. “Women and their doctors have been uncertain about the effect of multiple sclerosis on pregnancy, and some women have chosen to delay or even avoid pregnancy due to the uncertainty. We found that women with multiple sclerosis did not have an increased risk of most pregnancy complications.”
Chakravarty said that previous studies on multiple sclerosis and pregnancy have focused on the impact of pregnancy on disease activity.
The study also looked at women who had diabetes prior to becoming pregnant (not gestational diabetes), and found that they had higher rates of complications than women with multiple sclerosis and high rates of complications in areas where the women with multiple sclerosis did not have increased rates.
The National MS Society offers this advice for women with MS contemplating pregnancy:
1· There is no evidence that MS impairs fertility.
2· Pregnancy has not been shown to worsen symptoms of MS, and some studies have found a reduction in MS exacerbation in the second and third trimester, possibly due to an increase in the levels of natural corticosteroids that circulate during pregnancy.
3· Some symptom increase is reported in the first three to six months after delivery, and the risk of relapse in the postpartum period is estimated to be about 20-40%.
4· Avonex, Betaseron, Rebif, Copaxone, Novantrone, or Tysabri are not approved for use during pregnancy, so women are advised to discuss their medications with their physicians prior to becoming pregnant. These drugs are also not recommended for use while breastfeeding, because it is not known if they are excreted in the breast milk.
5· Women who use steroids for acute MS exacerbations may continue to use them during pregnancy, but should be carefully monitored by their obstetrician.
6· Women with gait difficulties may find that this worsens in late pregnancy as they become heavier and their center of gravity shifts. Use of assistive devices for ambulation is advisable, such as a wheelchair or walker.
7· Bowel and bladder problems may be aggravated in women with MS who have pre-existing dysfunction.
8· MS patients may feel more fatigued during pregnancy than healthy women.
The Epilepsy Foundation offers this advice for women with epilepsy contemplating pregnancy:
1· More than 90% of women with epilepsy will have normal, healthy infants.
2· Fertility rate may be about 25-33% lower than average, but personal choice may play a role. Also, women with epilepsy have a higher incidence of menstrual irregularities, polycystic ovary disease, or other endocrine disorder that may reduce fertility.
3· Folic acid supplementation is especially important for women with epilepsy both prior to conception and during pregnancy to reduce the risk of neural tube defects.
4· Trimethadione may be contraindicated in women contemplating pregnancy because it has been associated with a high incidence of fetal loss and congenital malformations.
5· During pregnancy, one-fourth to one-third of women will have an increase in seizure frequency despite continued use of medication because of decreased protein binding, increased drug clearance, and increased maternal plasma volume. Women should be closely monitored by their obstetricians during the prenatal period.