Family planning is very similar to it sounds. The process implies deciding how many children you want and when you expect to get pregnant. It sounds quite simple, but in reality it is complex. Important factors such as contraception, fertility and postpartum attention are part of the process, and as most of us know, life does not always go according to the plan.
The health of the person who takes the child is the most important piece of the puzzle. And for people with multiple sclerosis (EM), the severity of the disease and symptoms vary from person to person. Therefore, there are unique considerations regarding family planning with EM, and there are no two equal plans.
Not long ago that people with EM discouraged from becoming pregnant because it was thought that pregnancy gets worse. But investigation It shows that this is not the case: pregnancy itself does not have a negative impact on EM or worsens. In fact, some people with ES can even experience less inflammation and less relapses during pregnancy.
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Despite the fact that pregnancy is not harmful to people with EM, there is still much that patients and medical care suppliers (HCP) do not know about care before, during and after pregnancy. These gaps may include how to handle disease -modifying therapies (DMT), Assisted Reproductive Technologies (Art), Breastfeeding and postpartum relapses.
«It is common in patients with EM to receive mixed messages from doctors who may not be so updated on the latest management guidelines, and this can affect their birth experience and general results,» said Carrie M. Hersh, DO, MSC, FAAN, director of the Health and Welfare Program of Multiple Sclerosis in Cleveland Lou Ruvo Center for Brain Health in Las Vegas.
Hersh said that an early and proactive approach to family planning that involves the entire care team (when possible) can help people make informed decisions about what is best for their health.
«One of the questions I ask during a new visit is whether the patient wants to start a family, grow a family and if there is consideration when it could happen,» said Hersh. «Having a good understanding of the moment will be useful, especially when we are thinking about disease -modifying therapy.»
Read: Questions to ask your neurologist if you have more >>
Contraception and more
Contraception allows the «planning» part of family planning. For people with EM, some types of contraception may be more difficult to use (cervical cover, condom, etc.) depending on the symptoms of the disease. In this case, reversible contraceptives for prolonged action (LARC) can be an option to prevent pregnancy.
Contraceptive pills can also be an option, but can interact with certain EM medications, so it is important to talk to their PC about their specific situation.
Fertility and more
For many women and people assigned to women at birth (Afab), becoming pregnant is an unpredictable factor in family planning. But research shows that EM does not affect fertility or ability to get pregnant.
When it comes to infertility treatments, some small studies suggest that in vitro fertilization (IVF) can cause relapses in people with EM. However, a 2023 study It did not find an additional risk of relapse associated with fertility treatments, including IVF. Hersh said it is better to consult a fertility specialist to review general security and their health. “In terms of fertility treatment in EM, we do not have as many data as we would like to provide more guidance. But in general, EM people can use treatments to support fertility. »
Medications during pregnancy
Medications and DMT play a crucial role in the management of EM, but surprisingly many people do not need medications during pregnancy. «The symptoms of EM anecdotically improve during pregnancy, and EM is not in itself a high risk condition during pregnancy,» said Hersh.
However, taking certain medications before and during pregnancy can cause damage to the fetus. And there may be specific amounts of time to wait between taking the medication and getting pregnant. For example, people must wait six months after stopping the exhaustion therapies of B cells before becoming pregnant, according to the Food and Medicines Administration (FDA).
Breastfeeding and beyond
Some DMT and medications are not recommended if you are breastfeeding, so it is important to talk about early breastfeeding in the family planning process. This will help you find out when it is better to start taking your DMT again if you have to stop.
For people with EM, there may be an additional benefit to breastfeeding: a Metanalysis Of 24 studies they found that the people who breastfed had less postpartum relapses compared to the people who did not breastfeed.
According to Hersh, there is evidence that the amount of DMT that is transferred to breast milk is very small, which means that some women could breastfeed and take their medication at the same time in some cases.
It is also good to keep in mind that alternative medications, such as antidepressants, spasticity medications and bladder control medications, can help with EM symptoms instead of DMT in the short term.
The key is to speak with your HCP and your attention team on your family’s planning objectives to make sure everyone is on the same page. «When there is open communication and collaboration, that can only improve the long -term general health of the mother and her baby,» said Hersh.
This educational resource was created with the support of Novartis, a member of the Corporate Advisory Council of Greetings.
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