People with multiple sclerosis (MS) can get pregnant and have healthy pregnancies and babies in the same way as people without the condition. They can also have a vaginal delivery if they choose.

Pregnancy changes the way the immune system behaves so that the body does not attack the developing baby as an intruder. These changes can also shift symptoms of MS.

Many people with MS report a reduction in symptoms during pregnancy and a relapse in the postpartum period. However, each person is different, and there is no way to predict how an individual person’s condition will change during and after pregnancy.

Many MS medications are not safe during pregnancy, so people trying to conceive a baby may need to stop these drugs before getting pregnant. The Food and Drug Administration has not approved any disease-modifying therapies (DMTs) for pregnant people, but they may still be safe to take. A person can discuss these risks with their doctor.

Read on to find out more information about how MS may affect pregnancy.

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MS does not appear to have a significant effect on most pregnancy outcomes. It is generally safe to get pregnant with MS, and people with MS typically have healthy babies. It is also safe to breastfeed with MS.

The specific symptoms of MS a person has might affect pregnancy. For example, MS-related damage to the pelvic muscles and nerves may make it more difficult to push the baby out. This can increase the risk of assisted deliveries, and in some more severe cases may require a cesarean section (C-section) for delivery.

MS may affect a person’s ability to get pregnant, especially when the disease makes sexual intercourse difficult or painful. Rates of artificial insemination are higher among people with MS than those in the general population.

Additionally, some MS drugs might cause problems in pregnancy, although further studies are needed to confirm this. The FDA classifies most DMT drugs as class C drugs, which means that animal studies have shown a risk to the developing fetus. This presents serious ethical issues associated with studying these drugs in humans, so most doctors recommend against them.

However, the benefit of these drugs may outweigh the risk in some cases, especially if a person’s symptoms are severe. Additionally, these drugs may not have the same effects on humans that they do on non-human animals.

A 2019 study of 142 pregnancies found that pregnancies with first trimester exposure to several DMTs had comparable outcomes to those with no exposure.

Changes in sex hormones such as progesterone and estrogen during pregnancy may also affect the symptoms of MS.

Several studies suggest that MS symptoms generally improve during pregnancy and that the number of flare-ups decreases — especially during the third trimester.

Changes in the immune system during pregnancy tend to reduce the levels of various inflammatory chemicals. At the same time, these changes promote higher levels of certain anti-inflammatory chemicals that may help ease MS symptoms.

A 2018 paper explains that human chorionic gonadotropin, a pregnancy hormone, may change the behavior of specific white blood cells in a way that reduces immune system activation. This in turn reduces inflammation, potentially easing the symptoms of MS.

While pregnancy reduces excessive activation of the immune system in most people, not all people with MS experience a reduction in symptoms during pregnancy. Stopping certain MS drugs, particularly DMTs, during pregnancy may make symptoms worse and may increase the risk of severe relapses.

MS does not increase the risk of serious injuries to the baby, such as miscarriage, stillbirth, or severe congenital disabilities.

Data on the risk of MS to the birthing parent are contradictory. Earlier research suggested that rates of C-sections, stalled labor, or assisted vaginal delivery may be higher among people with MS, though this finding only came from one case study. More research is needed to confirm this claim.

A 2021 study in which 1 in 24 pregnant people had MS found no difference in major complications when compared with those living without MS. The condition did not increase the risk of emergency C-section, gestational diabetes, preeclampsia, or placenta issue.

There was, however, a higher rate of elective (non-emergency) C-sections among people with MS. Babies were also more likely to be born small for their gestational age — a risk factor for other health complications in the baby. The babies of people with MS had lower rates of asphyxiation symptoms.

People with MS do not usually need special obstetric care during pregnancy. They are candidates for vaginal delivery as long as they do not have other complications that prevent that option.

However, a person with MS should consider contacting an MS specialist before getting pregnant to weigh treatment options. Managing the condition before getting pregnant may be an effective way to increase a person’s chances for an uncomplicated pregnancy. Ongoing consultations with a specialist can help manage symptoms and make medication decisions. DMTs are not the only treatment option for MS.

Anesthesia, including epidural anesthesia, is safe for pregnant people with MS unless they have another complication that makes anesthesia unsafe.

People with MS should consider working with an obstetrician or midwife who has experience with MS and who is willing to support the pregnant person’s desires for the birth. MS alone is not an indication for surgical delivery, so people who prefer to avoid such deliveries should discuss this with a professional early in the pregnancy.

The postpartum period may be more difficult for people with MS, who face a higher risk of MS symptoms.

The sudden change in hormones and many other factors may increase MS symptoms postpartum. A 2018 paper suggests that chemicals associated with breastfeeding may also promote MS symptoms.

Some research suggests that being pregnant might also slow the progression of MS and result in lower rates of long-term disability.

For example, a 2016 study that followed 2,466 people with MS for 10 years found lower disability scores among people who had more pregnancies.

Researchers do not know what might cause this effect, though a 2018 review suggests that pregnancy might cause epigenetic changes that alter the course of MS. Epigenetic changes shift the way genes are expressed, changing the effect of various genes.

However, not all studies have found this correlation, so there is no scientific certainty about whether, why, or to what extent pregnancy might change the long-term course of MS.

While MS is a risk factor for depression, it may not increase the risk of postpartum depression. A 2021 study found similar rates of depression among postpartum people with MS as compared with people without MS. The study did not find a correlation between MS severity or symptoms and developing depression.

The study’s authors caution that their data may underestimate the rates of depression due to inadequate screening.

Some questions to ask a professional before getting pregnant include:

  • Is it safe for me to get pregnant?
  • Do I need to change medications before getting pregnant?
  • What can I do to improve my chances of getting and staying pregnant?

Some questions to ask during pregnancy include:

  • Is my pregnancy high risk?
  • Do I have any pregnancy complications?
  • How might MS or other complications affect my birth?
  • Are you comfortable with my birth plan?
  • What might change my birth plan?

Pregnancy may offer temporary relief from MS symptoms and could improve long-term MS outcomes. However, every person’s experience is different, so there is no guarantee of any specific outcome.

For most people with MS, the disease does not preclude or complicate pregnancy. It is still possible to choose from a wide range of birthing options and settings. People with MS can and do give birth to healthy babies.

To increase the odds of a good outcome, consider consulting with both an MS specialist and a midwife or obstetrician before trying to conceive. Changing to a safer treatment plan before pregnancy may reduce the risk of complications, though taking DMT drugs does not necessarily mean the baby will be unhealthy.

Talk with a doctor to determine the risks and benefits of all MS treatment options before, during, and after pregnancy.