Pregnancy and multiple sclerosis.

Multiple sclerosis (MS) is often diagnosed among women of childbearing age. This article reviews how MS affects pregnancy and provides information for health care providers who care for women with this disorder. Women with MS need to be informed regarding how the disease will affect their reproductive health. The disease itself does not usually have a negative impact on fertility or pregnancy, although some studies indicate that women with MS have a slightly increased risk for having small-for-gestational-age newborns. Some of the common MS symptoms such as fatigue, urinary frequency, constipation, and mood changes are similar to pregnancy-related symptoms. Mode of birth and anesthesia choices are similar to those for women without MS. Immunomodulatory therapy for MS needs to be discontinued before conception because most of the medications are still under investigation with regard to safety during pregnancy or have adverse effects on pregnancy. Relapse rates are increased for up to 6 months in the postpartum period. Breast feeding does not appear to increase the risk of postpartum relapses. All hormonal contraception can be used by women with MS. Some studies suggest that estrogen may have protective effects against disease progression.