Family planning is a lot like it sounds. The process involves deciding how many children you want and when you hope to get pregnant. It sounds simple enough, but it’s actually complex. Important factors such as contraception, fertility and postpartum care are all part of the process, and as most of us know — life doesn’t always go according to plan.
The health of the person carrying the child is the most important piece of the puzzle. And for people with multiple sclerosis (MS), the seriousness of the disease and the symptoms vary from person to person. So, there are unique considerations regarding family planning with MS, and no two plans are the same.
It wasn’t long ago that people with MS were discouraged from getting pregnant because it was thought that pregnancy made the disease worse. But research shows that’s not the case — pregnancy itself does not have a negative impact on MS or make it worse. In fact, some people with MS may even experience less inflammation and fewer relapses during pregnancy.
Read: How MS Affects the Body >>
Despite the fact that pregnancy isn't harmful for people with MS, there’s still a lot that patients and healthcare providers (HCPs) don’t know about care before, during and after pregnancy. These gaps can include how to manage disease-modifying therapies (DMTs), assisted reproductive technologies (ART), breastfeeding and postpartum relapses.
“It’s common in patients with MS to receive mixed messages from clinicians who may not be as up to date on the latest management guidelines, and this can affect their birth experience and their overall outcomes,” said Carrie M. Hersh, DO, MSc, FAAN, director of the Multiple Sclerosis Health and Wellness Program at the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas.
Hersh said an early, proactive approach to family planning involving the entire care team (when possible) can help people make informed decisions about what’s best for their health.
“One of the questions that I ask during a new visit is whether or not the patient wishes to start a family, grow a family and if there is consideration of when that might occur,” Hersh said. “Having a good understanding of the timing will be helpful — especially when we're thinking about disease-modifying therapy.”
Read: Questions to Ask Your Neurologist If You Have MS >>
Contraception and MS
Contraception allows for the “planning” part of family planning. For people with MS, some types of contraception may be harder to use (cervical cap, condom, etc.) depending on the symptoms of the disease. In this case, long-acting reversible contraceptives (LARCs) can be an option to prevent pregnancy.
Birth control pills may also be an option, but they may interact with certain MS medications, so it’s important to talk to your HCP about your specific situation.
Fertility and MS
For many women and people assigned female at birth (AFAB), getting pregnant is an unpredictable factor in family planning. But research shows MS does not affect fertility or the ability to get pregnant.
When it comes to infertility treatments, a few small studies suggest in-vitro fertilization (IVF) may cause relapse in people with MS. However, a 2023 study found no extra risk of relapse associated with fertility treatments, including IVF. Hersh said it’s best to consult a fertility specialist to review the overall safety and your health. “In terms of fertility treatment in MS, we don't have as much data as we would like in order to provide further guidance. But overall, people with MS may use treatments to support fertility.”
Medication during pregnancy
Medication and DMTs play a crucial role in managing MS, but surprisingly many people don’t need medication during pregnancy. “MS symptoms anecdotally are improved during pregnancy, and MS is not in itself a high-risk condition during pregnancy,” Hersh said.
However, taking certain medications before and during pregnancy may cause harm to the fetus. And there may be specific amounts of time to wait between taking the medication and getting pregnant. For example, people should wait six months after stopping B-cell depleting therapies before getting pregnant, according to the Food and Drug Administration (FDA).
Breastfeeding and beyond
Some DMTs and medications are not recommended if you're breastfeeding, which is why it’s important to talk about breastfeeding early in the family planning process. This will help you figure out when it’s best to start taking your DMT again if you have to stop.
For people with MS, there may be an added benefit to breastfeeding: One meta-analysis of 24 studies found that people who were breastfeeding had fewer postpartum relapses compared to people who didn’t breastfeed.
According to Hersh, there’s evidence that the amount of DMTs that transfers to breast milk is very small, which means some women could breastfeed and take their medication at the same time in some cases.
It’s also good to note that alternative medications, such as antidepressants, anti-spasticity drugs and bladder control medication, may help with symptoms of MS in place of DMT in the short term.
The key is talking to your HCP and your care team about your family planning goals to make sure everyone is on the same page. “When there is open communication and collaboration, that can only improve the overall long-term health of the mother and her baby,” Hersh said.
This educational resource was created with support from Novartis, a HealthyWomen Corporate Advisory Council member.
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