If you have a diagnosis of multiple sclerosis (MS), you face everyday challenges. Depending on which nerve signals the MS has disrupted, you may experience:

  • numbness
  • stiffness
  • muscle spasms
  • dizziness
  • difficulty focusing and organizing
  • emotional changes

What about the not-so-obvious ways in which MS may affect your life? For example, can or should you have a baby?

Here are some factors to consider.

Will I be able to get pregnant? Could pregnancy worsen my MS? What if I can’t organize nutritious meals for the baby? How will I chase a toddler around the house?

If you’re considering parenthood, these are all practical questions you may be asking yourself.

Recent research can answer some of them. Generally, the answer is yes, it’s safe to become pregnant if you have MS.

In fact, a 2016 study states that MS is more common in women of childbearing age than in any other demographic. Medical management and a supportive team will be key to a successful pregnancy.

Research shows that overall risk of fetal complications during pregnancy is no different for those with MS than it is for those without MS.

A 2019 study found that women with MS were more likely to have preterm births, but there’s no evidence that having MS increases your risk of cesarean delivery or congenital differences.

Depending on your symptoms, your doctor might recommend specific medications or birthing positions that can make your delivery experience more comfortable. However, people with MS generally don’t require special care during pregnancy and childbirth.

People living with MS need to plan for ongoing support when considering pregnancy. This planning begins with finding a neurologist and an obstetrician who can guide you in safely expanding your family.

Managing MS and being pregnant are challenging enough individually, let alone together. You should choose doctors who will help you sort through your concerns, steer you toward appropriate resources, and encourage you through any challenges.

Once you have a supportive clinical care team, discuss specific concerns with them. Questions you may ask include:

  • How will pregnancy affect my fatigue levels?
  • Can I take MS medications while pregnant and breastfeeding?
  • What if my MS relapses?
  • Will anesthesia during delivery adversely affect me?
  • What are the chances of passing MS on to my child?

You may wish to download the document Pregnancy, Delivery, and the Post Partum Period from the National Multiple Sclerosis Society to share with your doctors.

Multiple studies show that the following are generally no different regardless of whether someone has MS:

A 2019 study found that women with MS had a moderately increased risk of infections and a risk of preterm delivery that was 20 to 30 percent higher than in women without MS. However, the researchers also concluded that there was no increased risk of the following complications:

  • difference in fetal growth
  • preeclampsia
  • chorioamnionitis, a type of bacterial infection of the placenta
  • stillbirth
  • postpartum hemorrhage
  • major birth abnormalities

It’s not clear how the risk of pregnancy complications might change based on the severity of a person’s MS, and scientists have identified this as a gap in research. Canadian studies have found that those with more advanced disability were more likely to have cesarean delivery, assisted vaginal delivery, and induced labor.

Furthermore, research shows that MS flare-ups tend to decrease during pregnancy — especially in the latter two-thirds of pregnancy. Bladder, bowel, fatigue, and gait issues — common among all pregnant people — may be worse for people with MS who already experience those issues, though.

Medications for MS treat acute attacks, lessen symptoms, and slow the progress of the disease itself.

Medications for the first two purposes are usually safe to continue during pregnancy. If you take a disease-modifying agent, your doctor will advise you when to stop taking it — usually before you try to conceive.

Stopping some medications, such as natalizumab (Tysabri), may increase your risk of relapse. It’s important to talk with your doctor and weigh the risks and benefits of stopping medications before trying to get pregnant.

Research is limited around whether certain medications are safe during pregnancy. These medications include:

  • dimethyl fumarate (Tecfidera)
  • glatiramer acetate (Copaxone)
  • interferon preparations, such as:
    • interferon beta-1a (Avonex, Rebif)
    • interferon beta-1b (Betaseron, Extavia)
    • peginterferon beta-1a (Plegridy)
  • natalizumab (Tysabri)

Use them only if the possible benefits will outweigh the risks.

MS medications that aren’t safe to take if you’re pregnant include:

  • alemtuzumab (Lemtrada)
  • cladribine (Mavenclad)
  • fingolimod (Gilenya)
  • ocrelizumab (Ocrevus)
  • teriflunomide (Aubagio)

MS medications that shouldn’t be taken if you’re breastfeeding include:

  • alemtuzumab (Lemtrada)
  • cladribine (Mavenclad)
  • dimethyl fumarate (Tecfidera)
  • fingolimod (Gilenya)
  • ocrelizumab (Ocrevus)
  • teriflunomide (Aubagio)

Some studies have found that there’s an increased risk of relapse in the first 90 days after childbirth. Relapse rates may increase by anywhere from 11 percent to 25 percent. The relapse rate of 11 percent was seen in a group that had continuous health insurance and prescription drug coverage. The relapse rate of 25 percent was seen in studies where most participants had untreated MS.

A 2020 study suggests that exclusive breastfeeding could help reduce the risk of relapse in the postpartum period. While the study doesn’t prove or guarantee that breastfeeding will prevent relapse, it suggests that it isn’t harmful and could be beneficial for your health.

Some research suggests that having more prepregnancy MS relapses puts you at a higher risk for postpartum relapses.

MS-related disability and a higher relapse rate before or during pregnancy are also associated with more postpartum relapses, according to the 2020 study mentioned earlier. Despite this increased risk, most of the 67.2 percent of study participants whose MS wasn’t well-controlled prepregnancy did not have any relapses in their postpartum year.

Relapses in MS symptoms shouldn’t affect your abilities in the long term. However, you should anticipate fatigue in the short term.

Plan to focus on parenting, resting, and taking care of your health for the first 6 to 9 months after delivery. This might include prioritizing:

  • nutrition
  • exercise
  • social support
  • physical or occupational therapy

Arrange for other people to do household tasks and even babysitting, if possible.

Some studies have found an increased risk of peripartum and postpartum depression in people with MS, with those receiving an MS diagnosis during the postpartum period at an especially high risk.

MS is unpredictable, so you may feel life’s uncertainty acutely. However, when it comes to pregnancy and parenthood, everyone walks into unknown territory.

Support and rehabilitation after pregnancy is especially important for people living with MS. Actions you can take to help maintain independence and make the postpartum period more manageable include:

  • performing your normal daily activities
  • asking family and friends for help with childcare
  • developing an exercise routine to promote strength
  • using assistive devices such as canes, braces, or walkers
  • working with your clinical team to manage incontinence and motor skills

Additional helpful resources for MS include: