10 Tips on Family Planning
A group of doctors in the UK has developed guidelines on pregnancy in people with multiple sclerosis (Dobson and colleagues. Pract Neurol 2019;0:1-9). Here is a list of 10 things you should know about your family planning.
- MS doesn’t affect fertility in women or men. This means that you will need to use contraception if you’re taking a disease-modifying therapy for your MS. MS therapies do not reduce the effectiveness of oral contraceptives. People taking Tecfidera can have stomach upset, which may affect the absorption of an oral contraceptive, so additional contraceptive measures are advised.
- MS can cause sexual dysfunction. Sexual problems can be a direct effect of MS (such as loss of libido, erectile dysfunction, vaginal dryness) or an indirect effect (due to MS symptoms such as bladder problems, fatigue, muscle spasticity or depression). Talk to your neurologist or family doctor about treatments that can help with these problems.
- Discuss your plans with your MS team before you get pregnant. It’s best not to delay starting a disease-modifying treatment, but the choice of which therapy to take may be influenced by when you want to start trying to conceive.
- As a general rule, a disease-modifying therapy for MS should not be taken during pregnancy. Injectable drugs (Copaxone, an interferon) and Tysabri can be taken right up until pregnancy. With other drugs, you’ll need a period of time for the drug to wash out of your system before you become pregnant: at least 2 months for Gilenya; at least 4 months for Lemtrada; at least 6 months for Mavenclad; and 12 months for Ocrevus. Aubagio needs to be actively eliminated from the body with a course of treatment (cholestyramine or activated charcoal), which takes about 2 weeks. If you learn you’re pregnant while taking a medication, don’t stop the medication on your own – contact your MS team for advice as soon as possible.
- Relapses during pregnancy can be treated with a course of steroids. You can also have an MRI during pregnancy but use of a contrast dye for the scan (e.g. gadolinium) isn’t recommended.
- Stopping a disease-modifying therapy can increase the risk of relapses. While relapses tend to subside during pregnancy, about 1 in 4 women will have a relapse in the first few months after childbirth. Women with more active MS before pregnancy have a higher risk of relapse following a pregnancy. So the timing of stopping and restarting treatment is important to lower your risk of having a relapse. In some cases, it may be prudent to continue taking certain disease-modifying therapies during pregnancy – something you’ll need to discuss with your neurologist or MS clinic nurse.
- Women with MS don’t have more complicated pregnancies. MS doesn’t increase the risk of a miscarriage. Some MS symptoms may improve during pregnancy and some (e.g. fatigue, bladder symptoms, balance) may worsen. Be sure to tell your obstetrician that you have MS. Your MS team should also be kept in the loop so they can liaise with your obstetrician, midwife or other carers. If you have severe disability, this will need to be a consideration during pregnancy/childbirth. But MS doesn’t mean your pregnancy is automatically high-risk and will generally not have an impact on obstetric care (e.g. use of an epidural, vaginal delivery, etc.). Follow the same health advice as recommended for other mothers: don’t smoke, take the supplements recommended by your OB/GYN, and do pelvic floor exercises.
- Breastfeeding is important – but the timing is also important. There’s a higher risk of relapse during the postpartum period – precisely when you’ll be breastfeeding (if that’s your choice). Since treatment should generally be delayed until you finish breastfeeding, how long you breastfeed will need to be weighed against the amount of time you’ll be spending off treatment. Consider storing breast milk in the freezer so you’ll have a supply in case you need to re-start treatment early because of relapses. Re-starting treatment immediately after breastfeeding is recommended – but it may take several weeks or months (depending on the medication) for the treatment to become effective again.
- Talk to your MS team if MS symptoms are causing you problems. MS symptoms such as fatigue or weakness of the legs or pelvis can be challenging. Your MS team can refer you to a physiotherapist for help during your pregnancy, and can help you manage symptoms that are causing you difficulties caring for your baby.
- Get help if you are experiencing postpartum depression. Talk to your family doctor, neurologist or other healthcare professional if you are experiencing symptoms of depressed mood.
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