Is it possible to give birth to a child with multiple sclerosis? Pregnancy and multiple sclerosis. Procedure for treating MS

Multiple sclerosis is a type of nervous system disease. This disease usually occurs at a young age. The specificity of the disease is that simultaneous damage to certain parts of the nervous system occurs. For this reason, the patient exhibits various neurological signs. Multiple sclerosis can manifest itself through periods of remission and deterioration. Damage to the nerve sheaths occurs in the brain and spinal cord. The name for these small spaces is multiple sclerosis plaques. If the patient's condition worsens, the plaques may increase in size and merge with each other.

Causes

Multiple sclerosis occurs infrequently during pregnancy. This is explained by the fact that the expectant mother’s immunity is reduced so as not to harm the fetus by autoimmune reactions. The disease does not affect the course of pregnancy, and many mothers noted an improvement in their condition while waiting for the baby. For this reason, it is almost impossible to get multiple sclerosis during pregnancy. But there is a risk of the disease occurring during pregnancy. Multiple sclerosis occurs due to the destruction of the myelin layer of the brain. Sheaths surround nerve fibers, and myelin helps in moving impulses along them. When the myelin sheath is destroyed, the transmission of nerve impulses is disrupted, causing loss of control over the body. Despite the ability to restore myelin, with each attack of multiple sclerosis, scarring occurs on the membrane. The reason why there may be multiple sclerosis during pregnancy is a disruption of the immune system by the expectant mother. The exact cause of this phenomenon is still unknown. But many experts attribute disruptions in the immune system to the presence of viral infections in the body. Moreover, the infection can be transferred much earlier than pregnancy occurs. According to recent studies, the herpes virus affects the damage to the meninges. Experts also suggest that environmental pollution has a direct impact on the occurrence of multiple sclerosis.

Symptoms

If the expectant mother suffered from multiple sclerosis before conception, then during pregnancy she may experience signs of the disease, like other adults. The disease can occur in early and late pregnancy. The manifestation of sclerosis at the initial stage begins with numbness in the limbs and a feeling of muscle weakness. If the meninges are seriously damaged, there may be loss of vision or paralysis. Since the disease is not fatal, symptoms may disappear and reappear. During pregnancy, it is difficult to recognize multiple sclerosis at the initial stage. Weakness, fatigue and other early symptoms of the disease are similar to general signs of pregnancy. Multiple sclerosis in an expectant mother can be determined by the following symptoms:

• Numbness of the limbs;
• Gastrointestinal disorder;
• Weakness and fatigue, fatigue;
• Sudden change of mood;
• Forgetfulness, as well as impaired attention;
• Frequent urge and difficulty urinating.

Diagnosis of multiple sclerosis during pregnancy

The disease can only be diagnosed during pregnancy using magnetic resonance imaging. For this purpose, contrast agents are used to identify lesions in the myelin sheaths. If the expectant mother was diagnosed with multiple sclerosis before pregnancy, MRI may not be performed until delivery. An examination by a neurologist and an ophthalmologist is also necessary. The ophthalmologist will check your vision and the condition of the fundus.

Complications

Multiple sclerosis is not fatal. Complications that may arise in the presence of this disease include periodic manifestations of the disease. If you do not adhere to the necessary treatment, multiple sclerosis will manifest itself in a severe form. There is a violation of breathing and cardiac activity, due to which the body will not be able to function fully. In this case, disability is possible, and in some advanced cases, death.

Treatment

What can you do

There is no cure for multiple sclerosis. Despite the fact that many pregnant women do not experience an exacerbation of the disease, it is advisable to adhere to a diet. A special diet for patients with multiple sclerosis involves reducing the consumption of animal fats, red meat, and dairy products. But following a diet during pregnancy is necessary only after consulting a doctor. Since refusing some foods can cause a deficiency of useful elements that the baby needs. You can also consult your doctor about taking vitamin complexes.

What does a doctor do

During pregnancy, periods of exacerbation of multiple sclerosis may not occur. But if this happens, the doctor will prescribe the necessary medications. During pregnancy, the use of corticosteroids and drugs containing interferon is undesirable. Treatment of multiple sclerosis in pregnant women is carried out using plasmapheresis. This is a special device that helps in cleansing the body. If the expectant mother was diagnosed with multiple sclerosis before conception, and she took the necessary medications, then with the onset of pregnancy she needs to completely abandon them. When planning a pregnancy, stopping medications should occur 2 weeks before the expected date of conception.

Prevention

It is impossible to completely prevent the disease. But there is secondary prevention that helps to avoid frequent attacks of relapse. When planning a pregnancy, it is necessary to undergo a complete examination of the whole body. If viral infections occur, they should be eliminated immediately. Also, expectant mothers and those who dream of becoming one need to be less nervous, not smoke and lead a healthy lifestyle. Pregnant girls should visit an antenatal clinic for regular examinations, tests and examinations.

Multiple sclerosis is diagnosed mainly at a young age (15-25 years), while the incidence in women is two to three times higher than in men. Up to 10% of cases of the disease are caused by a genetic predisposition; the pathology can develop due to elevated blood sugar levels, lack of vitamin D, regular physical exertion or severe stress.

How compatible are pregnancy and multiple sclerosis? Twenty years ago, doctors did not know exactly how the patient’s body would react to pregnancy. But today it has been established that multiple sclerosis does not affect reproductive function. The risk of intrauterine growth retardation in the fetus with this maternal disease increases slightly, and the likelihood of serious pregnancy complications is the same as in healthy women.

General information about RS

Multiple sclerosis is a serious autoimmune disease that is associated with disturbances in signal transmission along nerve endings. Moreover, recently doctors agree that pregnancy and childbirth with multiple sclerosis are possible, although there are certain risks for the expectant mother (to a lesser extent for the child). Some experts insist on abortion when a woman with MS comes to register for pregnancy. In this case, it is necessary to find a qualified specialist, but at the same time soberly assess all the risks.

The first signs of the disease are increased fatigue and decreased performance, sudden short-term paralysis or muscle weakness, a feeling of numbness and tingling, frequent dizziness, visual disturbances, unsteadiness of gait, double vision, and problems with urination. As the disease progresses, the symptoms become more pronounced; they are supplemented by severe weakness of the limbs, decreased mental acuity and memory capacity, lack of sexual desire and other sexual disorders.

Life forecast

Due to somatic disorders, disability may develop. In some cases, the patient is not completely cured, progresses slowly, or several factors are combined. The young age of patients often allows us to hope for a favorable outcome. Unfavorable is usually associated with dysfunction of the brain and bladder. Long-term remission after the first attack suggests a favorable prognosis, and frequent relapses increase the risk of disability.

MS Treatment Methods

At the moment, there are no drugs that can completely cure multiple sclerosis. But the disease is progressive. Periods of exacerbation constantly alternate with periods of remission. Only adequate treatment can significantly prolong remission. Therapy is aimed at reducing inflammation and relieving symptoms.

Patients are recommended to have a healthy lifestyle. Regular physical activity is very important, aerobic exercise is especially beneficial. It is necessary to maintain optimal levels of vitamins and minerals, avoid overexertion (nervous tension is especially dangerous) and take proper rest, control body temperature, practice relaxing practices (meditation, yoga) and physiotherapeutic procedures (swimming, massages).

Psychological characteristics

Most women with MS are of reproductive age. Because of this, the issue of the combination of multiple sclerosis and pregnancy is especially relevant. Twenty years ago, women with such a diagnosis were immediately sent for an abortion; today doctors are not so categorical. Today, scientists have come to the conclusion that even with multiple sclerosis, pregnancy and childbirth can proceed quite successfully; the disease does not pose a threat to the life of the expectant mother and her child.

In some cases, doctors even recommend that patients become pregnant. The psychological component plays an important role here. But a woman who decides to give birth to a child must undergo a full examination at a medical clinic and receive competent advice from a neurologist before conception.

Perhaps doctors will dissuade a woman from pregnancy, so you need to be prepared for criticism. It is important to remember that a contraindication to conception, normal pregnancy and natural birth of a child is only a very severe form of MS, in which the patient is actually bedridden and cannot move independently.

With nervous disorders, the course of MS is worse than during pregnancy. So if a woman wants to give birth to a child and has no other contraindications, then she should be given a chance. Excuses and harsh criticism will lead to depression of the psychological state, which, as expected, will lead to a worsening of the course of MS. Abortion deals a blow to both the psychological and physical health of a woman.

Patients often fear that the disease will be passed on to the child. According to statistics, only three to five percent of children are susceptible to MS if one of the parents suffers from this disease. Multiple sclerosis itself is not transmitted, only a predisposition. This is the official opinion of doctors.

What a woman needs to know

Multiple sclerosis and pregnancy are quite compatible, but only under the supervision of a qualified doctor. This diagnosis does not provide any restrictions on the number of pregnancies and the age of the expectant mother. Any existing restrictions may only be due to other circumstances.

But it is worth knowing that during the period of bearing a child you should not take medications that are usually prescribed for multiple sclerosis. You should stop taking medications about two weeks before planning and then not resume taking them. Of course, all this must be agreed with the doctor.

Most women find out about their interesting situation only at 4-5 weeks of pregnancy, without stopping taking medications. In this case, you need to immediately stop taking the drugs, because they have a negative effect on the fetus. It is not recommended to have an abortion in such a situation, since in the first weeks the embryo is provided with a corpus luteum.

Course of pregnancy

During pregnancy, it is strictly forbidden to take medications that the woman usually took. The good news is that the risk of exacerbations during pregnancy is naturally reduced. Scientists from the University of Calgary have proven that the pregnancy hormone prolactin helps in the treatment of women with multiple sclerosis. In addition, the disease is characterized by the fact that the immune system begins to destroy myelin, and during the period of bearing a child, the woman’s body stops doing this.

The diagnosis of multiple sclerosis of the spine during pregnancy requires mandatory management of the expectant mother by a qualified gynecologist, neurologist and therapist from the moment the woman learns about her situation. You should not delay visiting the antenatal clinic.

Childbirth in women with MS

During pregnancy, multiple sclerosis usually does not appear. In addition, the disease is not a direct indication for a cesarean section. Childbirth is a completely autonomous process that is not affected by damage to the myelin sheath. The uterus contracts under the influence of hormones. Epidural anesthesia, according to many doctors from Western countries, is completely safe, but the right of choice still remains with the patient.

With a complicated pregnancy and exacerbation of multiple sclerosis, a woman may not feel the onset of contractions. Therefore, the expectant mother must remain in the hospital for the last few months. Doctors may need to artificially induce labor. At the same time, a woman with such a diagnosis needs to give birth faster, because the disease greatly tires the body, and fatigue sets in much faster than in healthy patients.

Multiple sclerosis and pregnancy: exacerbation

Exacerbations cannot be stopped with medications so as not to harm the child’s health. Thirty percent of women experience an exacerbation of the disease immediately after childbirth, and the vast majority - two or three months after the birth of the baby.

In the first trimester, the risk of exacerbation of multiple sclerosis during pregnancy (feedback from women confirms this) is high - up to 65%. This is why it is so important to undergo a medical examination as early as possible. The condition of those expectant mothers who have experienced frequent exacerbations of MS even before conception worsens more often. Fortunately, pregnant women tolerate exacerbations more easily, and their bodies recover faster.

Breastfeeding

Multiple sclerosis and pregnancy are an opportunity to forget about exacerbations for a while, since during pregnancy the immune system suppresses the manifestations of the disease. However, after childbirth, the risk of exacerbations not only returns, but also increases slightly. This is associated with the occurrence of chronic stress: the expectant mother does not get enough sleep, worries about the child and tries to breastfeed the child for some time, which is a contraindication to taking medications. Prolactin continues to be produced during breastfeeding, but doctors still recommend switching to artificial formula when the baby is two to three months old. After this, the expectant mother can resume taking medications.

Possible consequences of pregnancy

What are the consequences of pregnancy with multiple sclerosis? Many experts agree that in the case of a cesarean section, the negative consequences for the mother are minimized. Even in the absence of symptoms, it is necessary to undergo a medical examination, and, as a preventive measure, undergo therapy with immunomodulatory drugs. Pregnancy with multiple sclerosis (life expectancy for this disease is approximately 35 years after diagnosis) can help establish long-term remission.

Planning a pregnancy with your husband having MS

Before pregnancy, a couple should definitely consult a competent specialist. The husband may have to stop taking medications for a while. Otherwise there are no risks. The disease is inherited only in three to five percent of cases if one of the parents suffers from multiple sclerosis, in ten percent of cases - if both parents are diagnosed.

Multiple sclerosis and pregnancy is an important topic, since the disease is mainly diagnosed in young people. Most people diagnosed with a disease such as multiple sclerosis are women of childbearing age. Quite common questions relate to how multiple sclerosis affects pregnancy and labor and delivery.

Multiple sclerosis and pregnancy. Childbirth and possibilities.

Most couples in which one of the partners has multiple sclerosis are quite capable of having children without fear that the disease will adversely affect pregnancy, labor and delivery. Multiple sclerosis does not increase the risk of miscarriage or birth defects in the baby. Some women experience fewer symptoms of multiple sclerosis while pregnant, but symptoms return temporarily after delivery. But pregnancy, childbirth and early motherhood do not increase the risk of multiple sclerosis in the long term.

Some evidence suggests that pregnancy may help delay the disease for a long time in women who have been diagnosed with multiple sclerosis.

Plan ahead

If you have multiple sclerosis and want to have children, talk to your doctor. Here are the main points to think about and plan for:
— Some medications against multiple sclerosis are not recommended to be taken while pregnant. If you are taking any medications for this disease, use reliable birth control until you decide to become pregnant. Check with your doctor about when to stop taking these medications. In some cases, your doctor may advise you to hold off on trying to get pregnant until the relapse is over and you have stopped taking the medications.

— Some medications should not be taken during breastfeeding. The decision about when to restart medication after pregnancy is individual for each woman. Talk to your healthcare provider and consider your own values, wishes, and the severity of your illness.

— Some symptoms typical of pregnancy and the postpartum period may be worsened by multiple sclerosis. These include depression and fatigue. Plan ahead in case you need help with your work, household chores, or caring for your other children while you are pregnant and in the first few months after giving birth.

A child whose father or mother has multiple sclerosis has a higher chance of developing the same disease in the future than a child whose parents do not have the disease. The issue of pregnancy with multiple sclerosis in both parents is a priority.

Advice:

Contact an obstetrician who can monitor your condition during pregnancy and childbirth with multiple sclerosis. Find a specialist who is willing to work closely with the doctor who is helping you cope with your diagnosis!

Need help after childbirth

Some people with multiple sclerosis only lose their ability to work over time. Because of this, many couples either do not have children or try to have fewer children than they could if they were healthy. Other couples do not change their plans for their offspring after they find out that one of them has multiple sclerosis.

Both men and women with multiple sclerosis may need help to overcome sexual problems, such as problems with sexual arousal and ejaculation.

Given that fatigue, depression, and the use of medications during lactation are issues to consider after birth, you may need to let your baby's pediatrician know about your progress in multiple sclerosis.

Let's summarize:

Currently, multiple sclerosis is not a contraindication to pregnancy. A woman suffering from this disease has every chance of bearing and giving birth to a healthy child. A caesarean section is not necessary - childbirth can occur naturally. There are no contraindications for spinal anesthesia during childbirth.

During pregnancy, you should not take medications that affect the course of multiple sclerosis. Because of them, the fetus may experience birth defects. Fortunately, the risk of exacerbation of the disease in pregnant women is very low.

There is no need to be afraid. There is no need to listen to common “horror stories”. If you suffer from multiple sclerosis and decide to get pregnant, come for a consultation with a doctor at the Yusupov Hospital. You will receive detailed, competent recommendations and answers to all your questions.

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Prices for diagnosing multiple sclerosis

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Just 20 years ago, doctors did not know how exactly the body of a woman with multiple sclerosis would react to pregnancy. However, it has now been established that this disease does not affect reproductive function or a woman’s ability to bear and give birth to a healthy child. The risk of intrauterine growth retardation increases slightly. But, for example, the risks of developing serious pregnancy complications such as preeclampsia or arterial hypertension are the same as in healthy women.

Previously, it was believed that pregnancy sharply aggravates the course of multiple sclerosis. But now researchers have found that this is not at all the case. However, in antenatal clinics, patients with multiple sclerosis can still hear: “Have an abortion, otherwise there will be a serious complication and you will not get up after childbirth.” In fact, during pregnancy and childbirth, women with multiple sclerosis, as a rule, feel very well.

What does a woman with multiple sclerosis who is planning a pregnancy really need to know?

Firstly, because of this disease there are no restrictions on the number of pregnancies and the age of the expectant mother. Restrictions can only be related to some other circumstances.

Secondly, during pregnancy you should not take medications that are usually used for multiple sclerosis. Therefore, approximately two weeks before planning a pregnancy, you need to stop taking these medications and then not resume taking them. However, most women become pregnant while taking the drugs and find out about their situation already in the 3-4th week of pregnancy. Then you need to abruptly stop treatment, since these drugs are believed to have a teratogenic effect (affect the fetus). However, having an abortion in such a situation is not recommended.

The course of pregnancy and childbirth

During pregnancy, a woman should not take the medications she usually takes to control multiple sclerosis. Fortunately, the risk of exacerbations during pregnancy is reduced.

Unfortunately, obstetricians and gynecologists are often afraid to perform natural childbirth in women with multiple sclerosis. But childbirth is an autonomous process; damage to the myelin sheath cannot affect it in any way; the uterus itself contracts under the influence of certain hormones. Therefore, it is impossible to perform a caesarean section without indications, just because the patient has multiple sclerosis. As for epidural anesthesia, the available data indicate its safety, and doctors in civilized countries leave the right of choice to the patient.

Lactation

If during pregnancy the risk of exacerbations of multiple sclerosis decreases, then after childbirth it returns to its previous level or even increases slightly. The fact is that a woman has a stressful situation: she can’t get enough sleep, she has a lot of worries and worries. And this is one of the incentives for the development of exacerbation. But it is impossible to prescribe medications immediately after childbirth, since the woman must breastfeed the baby for some time, and this is a contraindication for taking medications.

Bibliography

• ICD-10 (International Classification of Diseases)
• Yusupov Hospital
• Gusev E.I., Demina T.L. Multiple sclerosis // Consilium Medicum: 2000. - No. 2.
• Jeremy Taylor. Health according to Darwin: Why we get sick and how it is related to evolution = Jeremy Taylor “Body by Darwin: How Evolution Shapes Our Health and Transforms Medicine.” - M.: Alpina Publisher, 2016. - 333 p.
• A.N. Boyko, O.O. Favorova // Molecular. biology. 1995. - T.29, No. 4. -P.727-749.

Multiple sclerosis, intimate sphere and pregnancy. Part 2. Planning. Contraception. Pregnancy. Childbirth. After childbirth.
Published on 01/08/2014 by admin
Planning a pregnancy

A woman planning a pregnancy or maintaining an existing pregnancy should, together with her husband, weigh their strengths in raising a child and assess the availability of support from family and friends.

It is necessary to discuss with a neurologist the possibility of continuing any treatment methods during pregnancy, as well as conducting a course of treatment before a planned pregnancy. Receiving DMT during pregnancy is prohibited. Drug withdrawal is carried out 3 months before the planned pregnancy.

If an exacerbation (manifestation) of multiple sclerosis occurs for the first time, then it is necessary to abstain from pregnancy for the time necessary to clarify the course of the disease. If there is a rapidly progressing course, then pregnancy planning should be postponed and inpatient treatment should be carried out. In general, this issue is complex, individual and requires a trusting relationship with the doctor and a competent approach on his part.

Contraception

While taking medications (DMTs, cytostatics, and others) or when there is an exacerbation of the disease, it is important to use a reliable method of birth control. The calendar method of birth control is extremely unreliable, since almost all women experience cycle disorders.

Antisperm pastes and vaginal suppositories do not affect multiple sclerosis, but they are unreliable and their use in some cases of multiple sclerosis is physically difficult. If suppositories and pastes are combined with the vaginal diaphragm, the reliability of contraception increases.

The intrauterine device is quite effective, can be used in a woman with multiple sclerosis for any treatment (hormones, immunomodulators...), and does not require any manipulation before or after sexual intercourse. But if sensitivity in the perineal area is impaired and there are severe spasms of the thigh muscles, it is not advisable to use an intrauterine device, because With this method of contraception, possible complications cannot always be identified in time. When treated with immunosuppressants (including corticosteroids), the risk of infections is increased. If there is a spiral, the woman should be observed by a gynecologist more often.

Hormonal contraception is quite effective. There is no evidence of its negative effect on the course of multiple sclerosis. Moreover, hormonal changes when taking contraceptives resemble those during pregnancy, when improvement is noted. When taking glucocorticosteroids (prednisolone, metipred...), the effectiveness of hormonal contraception may decrease, and then it is necessary to use additional methods of contraception. In addition, of the many medications taken, there may be some that, against the background of hormonal contraception, exhibit more severe side effects or themselves affect the activity of contraceptives. The attending physician must be warned about taking hormonal contraceptives.

Modern contraceptive hormonal drugs have an absolute contraceptive effect and at the same time the possibility of ovarian cancer, benign and malignant diseases of the mammary glands is significantly reduced, the condition of the skin improves... For patients with multiple sclerosis, it is better to use drugs that have a minimal hormonal load per cycle. For example, femoden, triquilar, triziston, triregol, miniziston, mersilon, microgynon, marvelon, regividon, cilest. The choice of drug is made by a gynecologist.

Inheritance of the disease

Multiple sclerosis is not a hereditary disease. A predisposition to autoimmune and allergic diseases may be inherited.

Pregnancy

Since 1980, 22 international studies have been conducted, covering a total of more than 13 thousand observations of pregnant women with multiple sclerosis. As a result, it turned out that during pregnancy, exacerbations of the disease occur less frequently, and in the first few months after childbirth, somewhat more often than in women who have not had pregnancy. After childbirth, in subsequent years, the frequency of exacerbations does not change. Exacerbations that develop after childbirth do not affect the long-term risk of disability. There is no evidence that with multiple sclerosis the risk of miscarriages, congenital anomalies, fetal death, complications of labor and delivery is greater than in the population.

Of course, with pronounced clinical changes and a malignant course of the disease, planning a pregnancy is categorically not recommended.

In general, almost all publications on the Internet are unanimous that pregnancy and childbirth do not in themselves cause exacerbation of multiple sclerosis. Moreover, in most cases there is improvement in this disease. This is associated with significant changes in hormonal conditions and natural immunosuppression. The mother's body suppresses cellular defenses so as not to “attack” the fetus.

In 3-12% of cases, a mild, short-lived exacerbation may occur in the first trimester, with complete recovery to its original state. The likelihood of these exacerbations depends on the frequency of exacerbations before pregnancy. If they are frequent, then the likelihood of exacerbation in the first trimester is greater. Termination of pregnancy, especially in the later stages, can cause severe exacerbation.

During pregnancy, women feel very weak. Especially in the first three months. Urinary incontinence increases due to the enlargement of the uterus and increased pressure on the bladder. Constipation and urinary tract infections may occur, especially with pelvic disorders. Given the presence of ataxia (unsteadiness), women need to be careful when moving and use the help of loved ones.

If there is sufficiently pronounced muscle weakness (paresis) and sensory disturbances, the woman should be under constant supervision in the last trimester and especially in the last month of pregnancy. This is necessary in order not to miss the onset of contractions. The neurologist, together with the obstetrician-gynecologist, decides on the method of delivery. If there is a neurological deficit that prevents natural childbirth, a caesarean section with epidural anesthesia is performed.

The method of pain relief does not affect the risk of exacerbation of multiple sclerosis. Both general anesthesia and epidural are used. I would like to note the negative impact of general anesthesia on the cognitive functions of the brain (memory, ability to concentrate).

After childbirth

In the first three months after childbirth, 20-40%, in the absence of prevention, experience “postpartum exacerbations.” They are associated with increased workload, deterioration of sleep, increased stress, reverse changes in hormonal conditions with the disappearance of natural immunosuppression. There are studies on the administration of intravenous immunoglobulins (Intraglobin, Intragam, Venimmun) after childbirth in order to prevent postpartum exacerbation. In case of exacerbation, pulse therapy with hormones is carried out (in this case, breastfeeding is avoided). After cessation of lactation, PMTRS is resumed.

Breastfeeding also does not cause exacerbation, but if fatigue is severe, a woman may decide to switch to artificial feeding.

So, in most cases, a woman suffering from multiple sclerosis can carry a pregnancy to term and achieve the happiness of Motherhood.