Women with MS who are pregnant or contemplating pregnancy may have concerns about the effect of pregnancy on the long-term course of MS. Few long-term studies have been performed. A retrospective study found no association between disability, and total number or timing of pregnancies relative to MS onset.¹³ There was also no association between disability, and onset or worsening of MS during pregnancy.

In a 1994 study of 39 Danish women with MS followed for 5 years, there was no evidence that pregnancy worsened the course of disease.¹⁴ However, the study was limited by its small size and dated in that immunomodulator therapy was not widely used at the time.

There is no evidence to suggest that MS affects fertility or leads to pregnancy loss or congenital malformations.^3,15 There is also no evidence of an increased incidence of preeclampsia, prematurity, or infant mortality.⁴ A 3-year prospective study found no difference in head circumference or weight between infants whose mothers had MS and those whose mothers did not.¹⁶

In general, women with MS can expect a pregnancy that is similar to that in women without MS. However, women with gait disturbances may experience greater difficulty during late pregnancy as their weight increases and their center of gravity changes. During pregnancy, women with MS may also experience an increase in bowel and bladder problems and in fatigue. In addition, spinal anesthesia during labor and delivery may be less preferable than epidural or regional blocks.^17,18

Women with MS may also be concerned about the safety of imaging during pregnancy. Although there are no data about the safety of MRI, there are no reports of fetal abnormalities associated with MRI scanning.⁵ MRI should be used only when its outcome will change a patient’s treatment plan.

Although pregnancy for women with MS is similar to that for women without MS, the postpartum period may be more difficult because of MS-related symptoms and the increased risk of relapse. One study found that 30% of women with MS had difficulty caring for their infants because of limb weakness or gait disturbances.¹⁹ In addition, individuals with MS who experience fatigue during the postpartum period may need additional help with child care.