Multiple Sclerosis and Pregnancy

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a chronic disease of the central nervous system. It is an unpredictable condition that can be relatively benign, disabling, or devastating. Some individuals with MS may be mildly affected, while others may lose their ability to write, speak, or walk when communication between the brain and other parts of the body becomes disrupted.

What causes multiple sclerosis?

There are many possible causes of MS, including viruses, autoimmune disorders, environmental factors, and genetic factors. All of the possible causes share the common feature that the body's immune system is prompted to attack its own nervous tissue. In particular, in MS, the immune system commonly attacks the layer of protein called myelin that surrounds the connecting fibers between parts of the central nervous system. This layer of protein normally provides insulation for the electrical signals that the nervous system uses to communicate. When this insulation is destroyed, communication becomes interrupted and ultimately parts of the nervous system are permanently destroyed.

What are the symptoms of multiple sclerosis?

Symptoms of MS are erratic. They may be mild or severe, and of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected. Throughout the course of the illness, an individual may experience any/all of the following symptoms, to a varying degree:

• Muscle weakness in the extremities

• Difficulty with coordination (impaired walking or standing may result, partial or complete paralysis is possible)

• Spasticity - the involuntary increased tone of muscles leading to stiffness and spasms

• Fatigue (may be triggered by physical activity, but may subside with rest; possible constant, persistent fatigue)

• Loss of sensation

• Speech impediments

• Tremor

• Dizziness

• Hearing loss

• Double vision

• Bowel and bladder dysfunction

• Sexual dysfunction

• Pain

• Emotional changes

Many people with MS experience cognitive impairments related to their disease. The effects of these impairments may be mild, often detectable only after comprehensive testing, and may include difficulty with any/all of the following:

• Concentration

• Attention

• Memory

• Poor judgment

The symptoms of multiple sclerosis may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How does pregnancy affect multiple sclerosis?

Fortunately, pregnancy does not appear to speed up the course or worsen the effects of MS. However, it is thought that women who have unrecognized MS may be more likely to begin having symptoms during pregnancy. Some studies have found that MS symptoms decrease in pregnancy and increase during the postpartum (after delivery) period.

How does multiple sclerosis affect pregnancy?

The disabling effects of the disease may make it physically difficult for the mother to carry a pregnancy. Muscle weakness and coordination problems may increase the likelihood for falls. Fatigue may worsen. Paralysis and wheelchair dependence may increase the risk for urinary tract infections.

Women in labor with MS may not have pelvic sensation, and may not feel pain with contractions. This may also make it difficult for them to tell when labor begins. Delivery of the baby may be more difficult in women with MS. While labor itself is not affected, the muscles and nerves needed for pushing can be affected. This may make Cesarean section surgery, forceps, and vacuum-assisted deliveries more likely.

How is multiple sclerosis managed in pregnancy?

Pregnant women with MS need close monitoring of the disease and of fetal well-being. More frequent prenatal visits are often needed. There is no established treatment that alters the course of MS. However, medications may be used in pregnancy including steroids and anti-inflammatory drugs. A procedure called plasmapheresis (a method for removing toxic elements from the blood) has been used in investigative trials for treatment of MS. Consult your physician for more information.

Rehabilitation for multiple sclerosis:

Supportive treatment and rehabilitation for MS are especially important during pregnancy. Rehabilitation varies depending upon the range, expression, severity, and progression of symptoms. MS rehabilitation may help to accomplish the following:

• Restore functions that are essential to the activities of daily living (ADLs)

• Help the woman to reach maximum independence

• Promote family involvement

• Empower the woman

• Educate the woman regarding the use of assistive devices (i.e., canes, braces, walkers)

• Establish an appropriate exercise program that promotes muscle strength, endurance, and control

• Re-establish motor skills

• Improve communication skills for women who have difficulty speaking because of weakness or incoordination of face and tongue muscles

• Manage bowel or bladder incontinence

• Provide cognitive retraining

• Adapt the home environment to emphasize function, safety, accessibility, and mobility