For 32-year-old Nikki Aragon of Craig, Colorado, the possibility of pregnancy was too good to be true. A diagnosis of multiple sclerosis and an unrelated uterine surgery led her to believe that having children with her husband wasn’t in the cards. Yet there she was early in February 2016, looking at the positive results of her home pregnancy test. So Aragon took another test, and then another. “Actually, I took eight pregnancy tests that day. I didn’t believe the first seven. They were all positive,” Aragon remembers. “Our dream was coming true.”
The Aragons sought advice to start their family, and Nikki’s health care team offered plenty of encouragement — a much different approach than the one used decades ago. “Women with MS were often advised to avoid pregnancy. There were concerns about the effect of MS on pregnancy, and whether the woman would be in good enough condition to care for a baby,” explains Dr. Riley Bove, assistant professor at the University of California San Francisco School of Medicine, and a neurologist at the UCSF Multiple Sclerosis Center.
There were also fears that pregnancy would make MS worse. Today we know that’s not the case. “If anything,” Bove says, “women who have several pregnancies tend to do well over time, in terms of their MS.”
[See: 10 Weird Mind and Body Changes That Are Totally Normal During Pregnancy.]
Challenges to Conceiving
In MS, the body mistakenly attacks the spinal cord, brain and optic nerves. The majority of cases — 85 percent — are characterized by attacks that come in waves or relapses, and then go into remission. An attack is typically signaled by the sudden onset of a new symptom, such as blurred vision, or the worsening of existing symptoms that include fatigue, numbness and tingling in the hands, trouble walking, bladder and bowel problems, and weakness.
When trying to conceive, it’s generally recommended that women stop taking medications that stave off relapses. How long in advance depends on the drug. “But going off medication increases the risk for relapse. So you have to determine which therapy is safest for the mother and baby,” says Dr. Bianca Weinstock-Guttman, professor of neurology at the University of Buffalo Jacobs School of Medicine, and director of the Jacobs MS Center for Treatment and Research.
Research suggests that patients can sometimes remain on older medications, such as glatiramer acetate (Copaxone) or interferon products, while trying to become pregnant. Weinstock-Guttman says we don’t have enough data about the effect on pregnancy from newer disease-modifying medications, such as dimethyl fumarate (Tecfidera) or Gilenya (Fingolimod).
Another potential challenge to conception: fertility. It’s not generally affected by MS, according to Cleveland Clinic. But about 10 percent of women with MS may have difficulty becoming pregnant, a 2016 study suggests. “Some small studies suggest MS may require reproductive intervention such as hormonal therapy or in-vitro fertilization. The older you are, the more you may need help,” Weinstock-Guttman says.
Otherwise, the same strategies that support conception in women without MS can help women with MS, such as:
— Taking prenatal vitamins with folic acid.
— Avoiding alcohol and smoking.
— Eating a healthy diet.
— Exercising.
— Maintaining healthy sleep habits.
What worked for Aragon was switching medications from rituximab (Rituxan) to Copaxone, exercising regularly and changing her diet. “I became pregnant within four or five months,” Aragon says.
[See: The 10 Best Diets for Healthy Eating.]
Managing MS During Pregnancy
With the exception of glatiramer acetate (Copaxone), MS drugs that reduce relapse risk are not considered safe for use during pregnancy. Fortunately, pregnancy lowers the risk of relapse, especially in the third trimester. It’s a phenomenon called the immunotolerant state of pregnancy. “In order for the mother to host and nourish the fetus, and help it develop, a number of immune changes have to happen. We think some of those immune changes may also lead to a decrease in relapses,” Bove explains.
Aragon noticed a reduction in symptoms right away. “I have a lesion on my spine that makes me have motion sickness. I thought with pregnancy it would be horrible, but I felt normal for the first time in a long time,” she says.
Not everyone feels better. Pregnancy may exacerbate MS symptoms such as fatigue, balance problems (especially with weight gain during pregnancy) and incontinence.
In order to navigate pregnancy with MS, it’s important to observe the same basic health guidelines from the conception period: avoid smoking and alcohol; take prenatal vitamins; get plenty of sleep; and eat a healthy diet rich in fruits, vegetables and legumes.
The following strategies can also help:
Assemble a good medical team. Make sure your neurologist and obstetrician communicate about your health.
Take vitamin D. While the risk of passing on MS to the unborn child is low ( about 3 to 5 percent), Weinstock-Guttman says that taking 1,000 to 2,000 IU of vitamin D per day may help reduce the risk further. But women should speak with their doctors about the ideal vitamin D dosing, which can vary in people with MS.
Exercise regularly. “Exercise reduces MS fatigue, keeps your muscles and joints healthy, and produces endorphins (the body’s feel-good chemicals),” Weinstock-Guttman says. There’s not a general recommendation for how much exercise you need. Weinstock-Guttman suggests daily walking.
Reduce other medications if possible. MS patients may be taking prescription drugs to treat spasticity, depression, low energy, or bowel and bladder problems. Talk to your doctor about the known medication risks to the child. You may need to slowly decrease your medications or be switched to another with fewer risks.
Prepare a support system. Arrange for family and friends to help care for the baby or do daily chores, such as cooking, cleaning and shopping. “Think about who’ll do the overnight feeding so you can get sleep,” Bove says.
When Baby Arrives
The relapse risk spikes when the baby is born, especially in women who had a high relapse rate prior to pregnancy. “About a third of women relapse postpartum,” Bove says. “The risk can last up to six months.”
Approaches to help reduce postpartum relapse include:
Breast-feeding. “Several studies have shown a lower risk of relapses in women who breast-feed, especially when the baby gets only breast milk,” Bove notes.
Going back on medications quickly. This is important if you had a high relapse rate before pregnancy. Once you’re back on medications, you’ll likely have to forego breast-feeding. “But monthly steroids as a bridge to restarting medications appears safe during breast-feeding,” Bove says.
Watching for mood changes. Women with MS have an increased risk for postpartum depression. Tell your family and doctor if you’re experiencing mood changes that affect your ability to care for your baby.
[See: The Fertility Preservation Diet: What to Eat If You Want to Get Pregnant.]
Lowering stress levels. Try yoga or meditation. “Psychological stress may increase the risk for postpartum depression,” Weinstock-Guttman says.
Aragon recommends leaning on your support system. She had a healthy baby girl in October 2016. “It’s been more rewarding than I could ever imagine,” she says, with her baby cooing in the background. “Pregnancy with MS was scary, but if you have the right support system, and you know you’ll be able to handle issues that come up, then you can do it.”
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Managing Pregnancy When You Have MS originally appeared on usnews.com
