MS Connection - Winter 2013

Jennifer is receiving prenatal care at S.H.E. Medical AssociMultiple sclerosis is a chronic disease of the central nervous ates, an affiliate of Saint Francis Healthcare Partners, located in system. It is an unpredictable condition in which symptoms Hartford. can be relatively benign, or, in worst case scenarios, disabling.

“Pregnancy is known to be accompanied with an increase Some individuals with MS may be mildly affected, while others in a number of circulating proteins and other factors that are may experience various degrees of paralysis. More than 6,000 natural immunosuppressants,” said Elizabeth Jensen, certified Connecticut residents, like Jennifer, battle the erratic and often nurse midwife and advanced practice nurse with S.H.E. Medbaffling effects of multiple sclerosis. ical Associates. “In addition, levels of natural corticosteroids Immediately following her diagnosis, Jennifer, who lives in are higher in pregnant than nonpregnant women. Researchers East Hartford, began researching the possible risks associatbelieve these may be some ed with pregnancy and multiof the reasons women with ple sclerosis. She brought her MS tend to do well during questions and concerns to her Pregnancy And Rehab pregnancy.” neurologist Peter Wade, M.D., After An Exacerbation Jennifer, who is due in DeDirector of Neurology at the cember, has little apprehenMandell Center for Multiple Some pregnant women with MS may require sion about postpartum issues, Sclerosis. He assured her that close monitoring of the disease. More frequent even though she understands she and Jeff could still have a prenatal visits could be indicated.

Should exacerbation rates tend to rise family, even in the face of MS. a mom-to-be experience an exacerbation, in the first three to six months According to the National supportive treatment and rehabilitation for MS after giving birth. The risk of MS Society, pregnancy does not are critical. Rehabilitation varies depending on a relapse during the postparappear to speed up the course or the range, expression, severity and progression tum period is estimated to be worsen the effects of MS. And of symptoms. Rehabilitation after an MS 20 to 40 percent. However, there is no evidence that MS studies indicate relapses do causes infertility. Several studies exacerbation may help to accomplish the not appear to contribute to of large numbers of women have following: increased long-term disabilirepeatedly demonstrated that Q Restore functions that are essential to the ty. One study showed that uspregnancy, labor, delivery and activities of daily living (ADLs) ing IV steroids once a month the incidence of fetal complicafor the first six months after tions are no different in women Q Help mom-to-be reach maximum delivery seemed to reduce the who have MS than in control independence relapse rate compared with groups. controls. However, there was Women are generally advised Q Promote family involvement no difference in neurological to stop treatment using disQ Educate mom regarding the possible use of function or progression, and ease-modifying medications one assistive devices (canes, braces and walkers) steroids have their own side to two menstrual cycles prior to effects. Most doctors in the trying to conceive. In Jennifer’s Q Establish an appropriate exercise program U.S. do not practice as stancase, she decided to delay onthat promotes muscle strength, endurance dard procedure the use of IV going therapy for her MS until and control steroids or other medications, after she has her child. such as IV immunoglobulin, “We really wanted to stick Q Re-establish motor skills after delivery and during the to the plan; we didn’t want Q Manage bowel or bladder incontinence postpartum period. my diagnosis to rob us of our According to Jensen, the commitment to begin a family Q Provide cognitive retraining only special concerns faced a year after our marriage,” said by pregna nt women who Jennifer. “I was diagnosed last have MS center around gait October and the next month difficulties, as women with we started trying. In April, I MS may find these worsen during late pregnancy when the received the exciting news that I was pregnant.” mothers-to-be become heavier and their centers of gravity shift.

Before 1950, most women with MS were counseled to avoid Increased use of assistive devices may be necessary, and may inpregnancy because of the belief that it might worsen the effects clude the use of a wheelchair at times. Bladder and bowel probof their MS. However, studies show the opposite is true. In lems, which occur in all pregnant women, may be aggravated most cases pregnancy actually reduces the number of MS exacin women with MS who have a pre-existing urinary or bowel erbations, especially in the second and third trimesters. dysfunction. Pregnant women with MS may also be more sub“It was amazing; almost as soon as I realized I was pregnant, ject to fatigue during the last few months of pregnancy. most of my symptoms vanished,” exclaimed Jennifer. “Until Jennifer plans to breastfeed her newborn. There is no then, every day I was reminded that I have MS. My symptoms evidence that breastfeeding increases relapses. Doctors recwere constant. My pregnancy has provided a reprieve from the ommend, however, that mothers with MS avoid the use numbness and tingling, the pain and the overwhelming fatigue of disease-modifying drugs because, as with many other associated with MS.” 6