How MS Affects Pregnancy And Childbirth
MS DOES NOT appear to affect the course of pregnancy, labor, or delivery. There is no increased risk of spontaneous abortions, labor or delivery complications, fetal malformations, or stillbirths. Therefore, couples do not need to be concerned that the mother's MS will affect her ability to have a normal, healthy baby.
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| MS Medications And Breastfeeding |
Anesthetics That Are Safe For Use During Labor Or Cesarean Section
EPIDURAL ANESTHESIA IS considered safe and effective for pain relief during labor as well as for surgery, in the event that a cesarean section is required. It is thought to be safer than spinal anesthesia, which has traditionally been avoided in all individuals who have MS. Although general anesthesia is considered safe for women who require cesarean section, most women seem to prefer an epidural anesthesia.
Medications That Are Safe For Use During Pregnancy
IDEALLY, WOMEN SHOULD seek medical advice before conception in order to review medications they are currently using, eliminate anything that is unnecessary, and substitute safer drugs where appropriate. While there are some medications that can safely be used during pregnancy without harm to the developing fetus, the recommended strategy is to review everything you are taking (both prescription and non-prescription) with your healthcare provider and take only those medications that have been specifically prescribed and/or approved for use during pregnancy. A woman who is taking medications and becomes pregnant should review those medications with her physician as soon as possible.
In particular, the disease-modifying medications - interferon beta 1a (Avonex and Rebif), interferon beta 1b (Betaseron), and glatiramer acetate (Copaxone) - are not approved for use during pregnancy. The beta interferon medications (Avonex, Betaseron, and Rebif) have all been given a Category C rating by the FDA, indicating that they have been shown in animal studies to increase the risk of miscarriage.
Copaxone has a Category B rating, meaning that no harm has been demonstrated in animal studies, but there are no data in humans to demonstrate their safety. Fortunately, these immunomodulating medications are not as critical during pregnancy because the hormones produced naturally by the woman's body during this time provide a similar degree of protection.
Pregnancy-related hormones work to reduce immune activity in order to prevent the mother's body from rejecting the "foreign" fetus. Because a fertilized egg begins to develop well before a woman knows she is pregnant, it is recommended that women stop their disease-modifying medication at least 1-2 menstrual cycles before trying to conceive. The medication can be resumed immediately after delivery if the woman chooses not to breastfeed her baby.
Mitoxantrone (Novantrone) and other chemotherapeutic agents that are sometimes prescribed in MS (e.g., cyclophosphamide, methotrexate, azathioprine) are all Category D or X, indicating that they are known to harm a developing fetus. Women are advised to take a pregnancy test prior to taking any of these medications and avoid becoming pregnant while taking them.
MS And Breast-Feeding
WOMEN WHO WlSH to nurse are encouraged to do so, provided that they have the requisite strength and stamina to manage the baby safely and do not require medications that would make nursing inadvisable. Breast-feeding has not been found to be associated with any change in the likelihood, timing, or severity of postpartum MS exacerbations.
For the first several weeks post partum, an infant should nurse every 2-4 hours in order to stimulate the growth of the mother's milk supply. Feedings can be at more frequent intervals during the day and every 4 hours during the night to allow the mother more extended periods of sleep. If at all possible, she should remain in bed for the nighttime feedings and let her partner (or another helper) bring the baby to her and then put the baby back to bed when the feeding is finished. Once the milk supply is well established, a breast pump can be used during the day to supply milk to be given by bottle at night. As an alternative, formula can be used for night feedings when the infant is approximately 2-3 weeks of age, after the mother has established her milk supply.
Because fatigue may adversely affect milk production, it is important for a new mother to have at least 8 hours of bed rest at night, rest time during the day. and sufficient help. Because these demands can rest quite heavily on a working father, creative predelivery planning is required to try to meet everyone's needs.
Many of the disease-modifying and symptom management drugs prescribed for MS are not recommended or approved for use during breast-feeding because they can pass into the breast milk and affect the baby. Since the choice to breast-feed means that a woman cannot resume taking her disease-modifying medication (Avonex, Betaseron, Copaxone, or Rebif), she should discuss the relative risks and benefits with her physician.
A woman whose MS was particularly active prior to pregnancy, or who experienced an attack during the pregnancy, might determine with her doctor that resuming her medication as soon as possible would be the best course of action. Another woman, whose disease has been relatively inactive, might decide to delay resuming her medication for as long as she chooses to breast-feed her baby. This is one of those situations for which there are no definitive answers. The choice is a very personal one, to be made after open and honest discussion with one's physician. To find out more, you can check out MS Medications And Breastfeeding.