For many people living with multiple sclerosis (MS), one of the first questions after diagnosis is whether they can still have a family. The answer is yes. MS does not make it harder to get pregnant, and labor and delivery outcomes match those of women without MS; however, pregnancy with MS goes best when it is planned.
The Corinne Goldsmith Dickinson Center for Multiple Sclerosis has launched a pregnancy planning program for people with MS. It was developed and is led by Anastasia (“Stacie”) Lyras, RN, a board certified Family Nurse Practitioner at the Center, where she provides compassionate, evidence-based care to people living with MS and other complex neurological conditions.
A member of the Center’s multidisciplinary Wellness Program, and she has a special interest in healthy lifestyle, mental health, and wellness in MS care. She serves as each patient’s main point of contact, working closely with the patient’s neurologist at every step of their pregnancy journey.
In this Q&A, she answers questions about the new program and what it means for patients planning a pregnancy.
Why is pregnancy planning so important for people with MS?
For some people, some MS treatments are not recommended during pregnancy, while other people may need a treatment-free interval before trying to conceive. Planning ahead means each patient has a clear, safe medication plan, and well-controlled MS before pregnancy begins. It is also a chance to address symptoms such as fatigue, spasticity (a stiffening of muscles), bladder problems, and mood changes. We also like to answer one of the common questions we receive from our patients: Will my child get MS? The reassuring answer is that most children born to parents with MS do not inherit the condition.
Anastasia (“Stacie”) Lyras, RN
How are MS medications handled around pregnancy?
Our program follows an evidence-based approach; however, every plan is individualized. A growing body of evidence supports safely transitioning patients to a high-efficacy treatments before conception, and some of these therapies provide long-lasting coverage throughout pregnancy. The team also reviews symptom medications ahead of time. If a relapse does occur during pregnancy, safe treatment options are available.
Does MS affect fertility or treatments like in vitro fertilization (IVF)?
No. Ovulation, egg supply, and egg quality are normal, and MS does not cause miscarriage or birth defects. For patients who need fertility treatment, studies of women taking medications that help manage MS have found that IVF does not increase the risk of relapses. The MS team co-manages care with the patient’s fertility specialist.
How can patients prepare before trying to conceive?
Preparing for pregnancy with MS largely follows the same recommendations as for anyone else, and the program provides education on each aspect, including the use of folic acid, prenatal vitamins, vitamin D, and vaccines. If a patient’s DMT affects vaccine timing, the team coordinates with the patient’s obstetrician.
What should patients expect after delivery?
MS is often quieter during pregnancy, thanks to natural hormonal and immune changes. After delivery, those changes shift back, so the program sets up the plan to restart treatment before the baby arrives. Breastfeeding is encouraged, and in most cases, patients do not have to choose between breastfeeding and their MS treatment.
Why does the MS team ask about mood after delivery?
Mood changes are common for all new parents, and for those living with MS, these changes can be harder to recognize, since exhaustion, brain fog, and poor sleep can have many causes. Because the MS team knows each patient’s baseline, the team is well positioned to notice changes. The team checks in at every visit and connects patients directly with mental health care if needed.
What if a pregnancy is unplanned, or ends in a loss?
Unplanned pregnancies are common and can be managed well. Patients should not stop their medication on their own and should contact the MS team, who will guide next steps and bring them into the pregnancy planning program. MS does not raise the risk of miscarriage. If a loss does occur, the team supports the patient, restarts treatment promptly, and offers referral for counseling.
Why did the MS Center create a family planning program?
Routine obstetric visits rarely are long enough to discuss MS medications, possible complications during pregnancy, or breastfeeding and MS treatment. The Center’s family planning program gives patients dedicated time to discuss these questions and make a plan with their MS care team. The visits begin before pregnancy and continue into the postpartum period, just as routine obstetric care is ending. This allows the team to plan for changes in treatment and care, and to address questions about symptoms, mental health, medications, and breastfeeding. For many patients, these appointments may be the only visits where their MS and their pregnancy are discussed together. The program also supports patients with neuromyelitis optica spectrum disorder (NMOSD) with a plan tailored to their individual needs.
What happens at each visit?
The preconception visit reviews the patient’s MS history, stability, and MRIs, and maps out a medication plan for conception. It also covers symptom medications, a mental health check-in, and what to expect after delivery. The third-trimester visit gets ahead of the postpartum period. Treatment, labs, and MRIs for after delivery are ordered and scheduled in advance, and patients receive breastfeeding guidance with support from the Center’s registered dietitian, who is also a lactation specialist. The four-week postpartum check-in is designed to ensure the plan is on track and includes another mental health check-in.
What makes Mount Sinai’s program different?
The program offers patients one shared, evidence-based starting point for medication and timing guidance, tailored to each patient’s disease activity, treatment history, and goals. Most importantly, a plan is made before pregnancy, not after a medication has been stopped abruptly.
How do patients learn more about the MS Center’s new Family Planning Program?
To learn more about the program, patients can call the Center at 212-241-6854 or email Belenmarie Mixon, Administrative Coordinator, at Belenmarie.Mixon@mountsinai.org.
This article is for general education and is not a substitute for individual medical advice. Patients with MS who are thinking about pregnancy should talk with their MS care team before making any changes to their treatment.