MS is usually diagnosed between the ages of 20-40, the age at which many people will be thinking of starting or adding to their family. While many people with MS feel better during pregnancy, more than half report fatigue and spasticity. Other symptoms may become more problematic during pregnancy and breastfeeding, such as bladder problems, pain and mood.
There is very little guidance on MS symptom treatments that are safe to take during pregnancy and breastfeeding. As a result, people often stop symptom treatments during pregnancy. But untreated symptoms such as depression, spasticity and nerve pain can have a big impact on quality of life during and after pregnancy. To fill this gap, a group of UK-based health professionals has drawn up evidence-based guidelines for symptom treatments.
A list of 24 treatments commonly prescribed during pregnancy was drawn up. For each of these medicines, evidence on safety during pregnancy and breastfeeding was gathered and used to assess each treatment for possible adverse effects as well as the impact of stopping them during pregnancy.
Recommendations cover commonly-used treatments for depression, pain, spasticity and walking, fatigue and sleep and urinary tract infections. For each symptom, treatment options are discussed and advice given on specific drugs. General principles include a personalised approach to weighing up risks and benefits to parent and unborn baby, involving the pregnant person in decision-making, and prescribing the lowest effective dose for the shortest period. The value of non-drug therapies is highlighted as an alternative to medication.
The clear guidelines, based on published evidence, drug registers and clinical expertise, will help people with MS and health professionals discuss the pros and cons of stopping, continuing, or changing symptom treatments at an early stage, ideally before becoming pregnant.
Background
MS is usually diagnosed between the ages of 20-40, the age at which many people will be thinking of starting or adding to their family. While many people with MS feel better during pregnancy, more than half report fatigue and spasticity. Some symptoms may become more problematic during pregnancy and breastfeeding, including bladder problems, pain and mood.
There is very little guidance on MS symptom treatments that are safe to take during pregnancy and breastfeeding. To fill this gap, a group of experienced health professionals have drawn up evidence-based guidelines for symptomatic treatments to support discussions between health professionals and people with MS.
How this study was carried out
A list of 24 treatments commonly prescribed for MS during pregnancy was drawn up from general practice records and feedback from MS neurologists. For each of these medicines, searches were carried out for safety during pregnancy and breastfeeding using international drug registries and published peer-reviewed research. This evidence was used to assess each treatment for possible adverse effects during pregnancy and breastfeeding as well as the impact of stopping them during pregnancy and a set of statements summarising key safety data was drafted.
A working group made up of MS specialist nurses, neurologists, obstetricians and pharmacists rated the statements on a scale of 1 to 5 (1 = strongly disagree, 5 = strongly agree). Statements were revised and circulated to the working group for a second round of scoring and final consensus statements were generated. At the same time, a group of 10 women with MS provided insight into treatments that they would consider during pregnancy, where they would look for this information and how they would like this information to be presented and made available.
What was found?
Recommendations cover commonly-used treatments for depression, pain, spasticity and walking, fatigue and sleep and urinary tract infections. For each symptom, treatment options are discussed and advice given on specific drugs.
The guidelines set out general principles for prescribing during pregnancy and after childbirth. These recommend a personalised approach to weighing up risks and benefits to parent and unborn baby, providing sufficient information to involve the pregnant person in decision-making, and prescribing the lowest effective dose for the shortest period. The value of non-drug therapies is highlighted and referral to mental health and physiotherapy services is encouraged as alternatives to medication.
What does it mean?
These guidelines are very welcome as they give clear and expert advice for pregnant and breastfeeding people with MS and for those who are planning a pregnancy.
Even though the majority of people with MS take at least one medication during pregnancy, only around 5% of these have been adequately monitored, tested and labelled with safety information for their use in pregnancy and breastfeeding. This lack of information means that people are often advised (and may also wish) to stop symptom treatments during pregnancy. But untreated symptoms such as depression, spasticity and nerve pain can have a big impact on quality of life during and after pregnancy. The clear recommendations, based on published evidence, drug registers and clinical expertise, will help people with MS and health professionals discuss the pros and cons of stopping, continuing or changing symptom treatments at an early stage, ideally before becoming pregnant.
These guidelines for symptom treatments complement previously published UK guidelines which cover the risks and benefits of taking disease modifying drugs before, during and after pregnancy. The two guidelines have been combined and published in Neurology and Therapy (listed below) which is available open access.
Iyer P, et al.
Developing evidence-based guidelines for the safety of symptomatic drugs in multiple sclerosis during pregnancy and breastfeeding: A systematic review and Delphi consensus.
Multiple Sclerosis Journal 2023; 29(3): 395-406.
Summary
Iyer P, Dobson R.
Multiple sclerosis in pregnancy: a commentary on disease modification and symptomatic drug therapies.
Neurology and Therapy 2023 Feb;12(1):1-10.
Full article
Conception, pregnancy and childbirth
Read more about pregnancy and parenthood in our A-Z of MS.
UK MS Pregnancy Register
To help build a picture of what is like to be pregnant with MS, the UK MS Pregnancy Register aims to collect data on the safety of disease modifying drugs and symptom treatments during pregnancy and breastfeeding. If you're pregnant and have MS, and would like to share your experiences of pregnancy with MS and help other people with MS make informed decisions, you can join the UK MS Pregnancy Register.
Symptom treatments
The mainstay of treatment for MS involves managing individual symptoms. Symptomatic treatments help relieve the physical or mental symptoms of the condition. They don’t treat the underlying cause or change the course of the condition itself. Depending on the symptom, management might involve medication, input from a therapist or rehabilitation specialist and/or the development of self-management strategies.
Use the MS Trust Treatment Finder to find out more about the drugs and treatments which are commonly used for MS, and the symptoms they can be used for.
