Multiple sclerosis living in pregnancy

Overview

Multiple sclerosis (MS) is a long-term condition where the body's immune system attacks the protective covering of nerves, causing communication problems between the brain and the rest of the body. During pregnancy, many women with MS find that their symptoms improve, especially in the second and third trimesters. However, careful management is important for both mother and baby.

MS affects about 1 in 1,000 people, and it is more common in women. Many women with MS are of childbearing age, so pregnancy is a common consideration.

MS is usually diagnosed between ages 20 and 40, which are also common childbearing years. It affects both sexes but is about 2–3 times more common in women.

Symptoms

Common symptoms

• Fatigue (extreme tiredness)
• Numbness or tingling in the arms, legs, or face
• Vision problems (blurred or double vision, vision loss in one eye)
• Muscle weakness or stiffness
• Balance problems or dizziness
• Bladder or bowel issues

Causes

Main causes

• The exact cause of MS is unknown, but it is believed to be an autoimmune condition where the immune system mistakenly attacks the myelin sheath that protects nerve fibers.
• Genetics and environmental factors both play a role.

Risk factors

• Family history of MS (a first-degree relative with MS increases risk slightly)
• Low vitamin D levels or living far from the equator
• Smoking
• Certain viral infections, especially Epstein-Barr virus, may trigger MS in genetically susceptible people

When to see a doctor

See a doctor urgently if:

• If you experience any sudden or severe neurological symptoms (e.g., loss of vision, paralysis, breathing trouble)
• If you have a high fever or signs of infection during pregnancy

Book a routine appointment if:

• Schedule regular check-ups with both your neurologist and obstetrician as recommended
• Discuss any changes in your MS symptoms at your routine appointments
• Talk to your doctor before becoming pregnant or as soon as you find out you are pregnant

Diagnosis

MS is diagnosed by a neurologist based on your symptoms, a physical exam, and tests that look for damage to nerves. There is no single test, but a combination of findings points to MS.

Tests that may be done

• Magnetic resonance imaging (MRI) of the brain and spine to look for areas of damage (lesions)
• Lumbar puncture (spinal tap) to check for certain proteins in the fluid around the brain and spine
• Evoked potentials (tests that measure electrical activity in the brain in response to stimuli)

What to expect at your appointment

If you already have MS, your diagnosis is known. During pregnancy, your doctor will monitor you with regular check-ups. You may have more frequent appointments to manage both the pregnancy and MS. You may need to stop or adjust MS medications, so it is important to discuss this with your healthcare team.

Treatment

There is no cure for MS, but treatments can help manage symptoms and reduce relapses. During pregnancy, the goal is to keep you and your baby healthy while controlling MS activity as safely as possible.

Self-care at home

• Get plenty of rest and listen to your body – fatigue is common
• Stay physically active with gentle exercises like walking or swimming, as advised by your doctor
• Eat a balanced diet rich in fruits, vegetables, and vitamin D sources
• Manage stress through relaxation techniques, yoga, or talking to a counselor

Medical treatments

Medical treatment for MS during pregnancy must be carefully chosen. Some disease-modifying therapies are stopped during pregnancy because of possible risks to the baby, while others may be continued under close supervision. Your neurologist will work with your obstetrician to decide the best plan. Treatments for relapses (like steroid medications) may be used in certain situations. Physical therapy, occupational therapy, and medicines for specific symptoms (like spasticity or bladder problems) may also be part of your care.

When is surgery considered?

Surgery is not a treatment for MS itself, but some people with severe mobility issues may undergo procedures like deep brain stimulation for tremors (rare). During pregnancy, surgery is avoided unless absolutely necessary.

Living with this condition

Living with MS and pregnancy means planning ahead for good days and bad days. Listen to your body, rest when needed, and ask for help from family and friends. Use assistive devices if needed, like a cane or walker, to prevent falls.

Lifestyle tips

• Avoid smoking and limit alcohol – both can worsen MS and harm your baby
• Maintain a healthy weight – excessive weight gain can worsen MS symptoms
• Get enough sleep – aim for 8 hours a night and take short naps if needed
• Stay social and connected to avoid isolation

Diet and exercise

Eat a well-balanced diet with plenty of fruits, vegetables, whole grains, lean protein, and foods rich in vitamin D (like fatty fish or fortified dairy). Gentle exercise, such as prenatal yoga, swimming, or walking, can improve your mood and energy levels. Always check with your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

Pregnancy can be an emotional time, and having MS adds extra stress. It is common to feel anxious or worried. Talk to your healthcare provider about your feelings – they can offer support or refer you to a counselor who understands MS. Remember, you are not alone, and asking for help is a sign of strength.

Prevention

MS cannot be prevented, but a healthy lifestyle may help reduce the frequency of relapses. Avoiding smoking, maintaining a healthy weight, and getting enough vitamin D are good practices. There is no proven way to prevent MS itself.

Vaccines

Speak with your doctor about vaccines during pregnancy. Inactivated vaccines like the flu shot and whooping cough (pertussis) vaccine are generally recommended. Live vaccines (like the MMR) are avoided during pregnancy. Your doctor can advise you based on your specific situation.

Screening programmes

There is no routine screening test for MS in the general population. If you have a family history or symptoms, your doctor may suggest an evaluation. During pregnancy, you will have regular prenatal check-ups to monitor your health and the baby's development.

Complications

If left untreated

• Untreated MS can lead to more frequent relapses and faster progression of disability over time, but this is not directly affected by pregnancy.
• If you stop all MS medication without medical advice, you may have a higher risk of relapses after giving birth.
• Poor management of symptoms (like bladder problems) can lead to infections.

Long-term outlook

The outlook for women with MS who become pregnant is generally very good. Most women have healthy pregnancies and deliver healthy babies. Pregnancy does not worsen the long-term course of MS. While there is a slightly higher risk of relapse in the first few months after delivery, this can be managed with medical supervision. With the right support and care, you can have a positive pregnancy experience.

Find support

International organisations

• Multiple Sclerosis International Federation

Local organisations

• National Multiple Sclerosis Society (US) · United States
• MS Society (UK) · United Kingdom

Helplines

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