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University Hospitals Dorset NHS Foundation Trust

Family planning and pregnancy in MS

Introduction

If you have Multiple Sclerosis (MS), there are some key things to think about when planning a family, including contraception. These should be considered whether you are planning to have a baby in the near future or not.

While family planning and pregnancy are often discussed in relation to women, it's also important for men with MS to consider how the condition might affect their plans to start a family.

Some key points:

  • MS will not usually directly affect fertility, pregnancy, labour or giving birth.
  • Some MS disease modifying treatments (DMDs) cannot be used when trying for a baby, during pregnancy, or breastfeeding. This will also apply to men trying for a baby with certain DMDs.
  • Having a new baby is exhausting and can be difficult for anyone, but can be more challenging for someone with MS. It is important to be kind to yourself and accept and ask for help.
  • Pregnancy does not increase the risk of worsening long-term disability.
  • Overall, relapse rate has been found to be similar during the pregnancy twelve months (nine months of pregnancy and three months following the birth) as in a non-pregnancy year. Whilst there is usually a reduction in relapse rate during pregnancy, about a quarter of untreated women (those not a disease modifying drug) will experience a relapse in the first three months following the birth of their baby.

I have no plans to conceive

MS does not affect fertility of men or women with MS. It is important to use contraception if you are not planning to conceive.

Contraception choice may be influenced by MS symptoms, MS disease modifying drugs (DMDs), and other treatments you are taking:

  • Some MS DMD treatments are not safe to use during pregnancy and may affect quality of sperm
  • Some symptoms of MS can make the use of some methods of contraception more difficult to use
  • Some medications used to treat symptoms of MS can increase the risk of hormone-based contraception failing

About 45% of pregnancies are unplanned. If you unexpectedly become pregnant, please contact the MS Service helpline to be booked into an appointment for an MS pregnancy consultation.

I am planning on trying for a baby

If you are planning on trying for a baby, please contact the MS helpline and ask to be booked in for a pre-conception consultation with one of our nurses/practitioners.This is usually a video consultation. At this appointment we will:

  • Talk about planning your pregnancy and offer you advice and information regarding all aspects of your MS and pregnancy
  • Ask you about previous pregnancies (if you have had any) and discuss any previous problems you may have had
  • Discuss MS symptom areas which may be relevant to pregnancy, labour, and the early days of being a parent
  • Discuss your current MS medication and whether it is safe to continue through the conception, pregnancy, and breastfeeding. It may be that we advise you to switch treatment during this period

Is there anything else I can do to help myself if I want to get pregnant?

  • If you smoke, we advise that you stop. You can refer yourself to smoking cessation programmes or support services to help you to do this. Smoking is harmful to you and your unborn baby. It is also more difficult to conceive if you do smoke
  • Start taking folic acid for 3 months prior to conceiving and during the first 12 weeks of pregnancy
  • Take a vitamin D supplement (400-800 IU per day)

I am pregnant

Make an appointment with your community midwife as early as possible. Contact your GP surgery to do this.

If you discover you are pregnant, inform the MS Service helpline. You will be booked into an appointment for an MS pregnancy consultation.

We do not advise suddenly stopping medications when you find out you are pregnant.

If you or your partner has MS and you become pregnant, the risk of miscarriage or serious pregnancy problems is not significantly higher than usual.

MS is not associated with an increased risk of blood pressure problems (pre-eclampsia) or growth problems for the baby. Extra growth scans are not required.

While many women find their MS symptoms improve during pregnancy, some symptoms may worsen, such as fatigue, heat sensitivity, bladder, and balance symptoms.

Urinary tract infections (UTIs) are more common in pregnancy and need to be identified and treated quickly. Contact your GP if you think you have a UTI.

Recommendations during pregnancy

  • If you smoke, we advise that you stop. You can refer yourself to smoking cessation programmes or support services to help you to do this. Smoking is harmful to you and your unborn baby. It is also more difficult to conceive if you do smoke
  • Folic acid should ideally be started 3 months prior to conception and continued until 12 weeks gestation
  • Vitamin D (400-800 IU per day) should be taken
  • Relapses can be treated with corticosteroids during pregnancy, but only on the advice of your neurologist or MS service
  • MRI scans are not contraindicated in pregnancy; however, gadolinium contrast (the dye that is sometimes used for MRI scans) should be avoided

Labour and delivery

MS does not automatically mean a pregnancy should be considered higher risk. A 'midwifery-led' delivery may be an option should you wish; this should be discussed with your midwife or obstetrician.

We would normally recommend a vaginal delivery as the safest type of birth for women with MS, but individual risk factors and circumstances need to be taken in to account. We are always happy to discuss options for delivery, in relation to your MS, with you and your obstetric team.

The full range of labour pain relief are available to women with MS. Your obstetric team can discuss this further with you.

Postpartum (Postnatal)

We support women's choice to breastfeed and offer individualised advice about the safety of medications in relation to breastfeeding. Some MS disease modifying drugs (DMDs) are not safe to use whilst breastfeeding – if you have any questions regarding this, please discuss with your MS nurse/practitioner.

Women with MS should continue to take vitamin D and their infants should be given vitamin D in line with standard advice.

People with MS may be more likely to feel low, depressed, or anxious after having a baby. If you feel this way, it's important to ask for help. You can speak to your health visitor, GP, or contact Steps2Wellbeing (see below) at any time if you're worried. More information on mood and MS can be found here Mood Section.

People with MS may require additional support from family and friends in the postnatal period. It is important that you accept help and ask for it.

MS symptoms you usually live with may become worse in the early days after having a new baby. It is especially important to let your MS Service know if you are having problems with your bladder or bowel function. We can also give advice on other symptom areas, including advice from MS Specialist Occupational Therapists and Physiotherapists, if required.

MS Preconception and Pregnancy Consultations

Planning a pregnancy and being pregnant with a long-term condition can be daunting. We run preconception and pregnancy consultations to provide specialist advice and reassurance.

These consultations are run by an MS Nurse or Practitioner with expertise in Pregnancy in MS; they will offer individual advice unique to you and help to support you through your pregnancy and beyond.

They may also link with your midwife, neurologist, and other members of the MS Service in order to give you the best advice and support.

You can refer yourself for one of these consultations by contacting the MS Service on 0300 019 2362 or This email address is being protected from spambots. You need JavaScript enabled to view it..

Further information

UK consensus on pregnancy in multiple sclerosis: 'Association of British Neurologists' guidelines UK consensus on pregnancy in multiple sclerosis: 'Association of British Neurologists' guidelines | Practical Neurology (bmj.com)

MS Trust: https://mstrust.org.uk/a-z/pregnancy

MS Society: https://www.mssociety.org.uk/pregnancy

MuMS UK - an online Facebook group who discuss all aspects of pregnancy and parenting, and for those who are thinking of starting a family: https://www.facebook.com/groups/351614711568755/

Live Well Dorset – support to stop smoking: https://www.livewelldorset.co.uk/stop-smoking

Steps2wellbeing - Free, confidential, NHS self-referral service for people experiencing problems with low mood/ depression, anxiety, stress, or other common mental health problems: www.steps2wellbeing.co.uk

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