BEFORE 1950, VIRTUALLY all published literature and medical opinion advised women with MS against becoming pregnant. It was believed that pregnancy would worsen the woman's MS, eventually making it impossible for her to parent effectively.
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| MS And Natural Childbirth |
Beginning in 1950, all evidence started to point in a different direction. Several studies were published presenting retrospective reports of women with MS who had given birth. Taken together, these studies examined more than 925 pregnancies. Only 10% of the women experienced any worsening of their MS during pregnancy, whereas 29% experienced temporary worsening of the disease within 6 months after delivery.
In 1998, a European study of 254 women and 269 pregnancies reported a 70% decline in exacerbation rate during the last trimester of pregnancy (an effect that is more than twice that of the current disease-modifying therapies, each of which reduces the relapse rate by about 30%). During the first three months after delivery, women experienced a rebound 70% increase in relapse rate before returning to their pre-pregnancy baseline relapse rate.
These findings have now been confirmed in several additional studies; the average expected rate of exacerbations in women decreases progressively over the course of pregnancy, indicating that certain pregnancy-associated hormones and immunoactive proteins protect a pregnant woman who has MS. Women generally report feeling better during their pregnancies than they felt before becoming pregnant. As a result of these findings, the pregnancy hormone estriol (a form of estrogen) is now being actively studied as a potential treatment for women with MS.
In addition, a retrospective study of 178 women with MS found no difference in long-term disability levels of women who had experienced zero, one, or two or more pregnancies. The researchers concluded that the number of pregnancies has no effect on a woman's ultimate level of disability. This finding is difficult to interpret, however, because it is possible that women with more severe disease chose to have fewer pregnancies than did women with less severe disease.
In a Swedish study, researchers concluded that pregnancy had both short- and long-term effects on the course of MS. In addition to the expected decreased risk of exacerbation during pregnancy, their findings suggested that women who have gone through a pregnancy after the onset of MS might have a reduced risk of developing a progressive course of the disease.
In summary, studies have consistently shown that a woman's MS is likely to be stable, or even improved, during the actual 9 months of pregnancy. These studies offer some reassurance for women who are concerned about stopping their disease modifying medication in order to become pregnant; the hormone produced during pregnancy offered at least as much protection as these medications. The risk of exacerbation following pregnancy has been found to range from 20-75% (regardless of whether the pregnancy goes to term or ends prematurely due to miscarriage or elective abortion). Most research supports the view that pregnancy does not affect the final course and degree of disability experienced by women with MS.
Long-Term Issues
THE LONG-TERM issues surrounding planning, pregnancy, and childbirth involve more complex questions and answers. Because MS is so unpredictable in its course and symptom picture, it is impossible for couples or their doctors to predict what the future will bring. Prospective parents with MS often ask whether they will be able to care for a child. Typically, they are picturing themselves attempting to hold, nurse, carry, or play with their new baby.
Although these are important concerns, they are only the beginning; babies do not remain babies very long. The individual with MS and his or her partner need to consider the following: their financial and emotional security as a couple; their individual views of parenting; and their ability to handle major role shifts within the family if they become necessary. To find out more, you can check out MS And Natural Childbirth.