70% of cases of multiple sclerosis are diagnosed in women between the ages of 20 and 40, that is, during the fertile period of life. However, adopting a positive perspective and improving advice on the risks of conception in the case of this disease has increased the number of patients who decide to become mothers.
Multiple sclerosis, an autoimmune disorder with no effective treatment, affects approximately 2.9 million people worldwide. In fact, it is the leading cause of progressive neurological disability in young people. Given its unpredictable evolution, it can be disabling or cause significant physical consequences.
Pros and cons of facing pregnancy
Historically, the impact of multiple sclerosis on pregnancy and vice versa was unknown, but a negative impact was suspected; up to the recommendation of termination of pregnancy and sterilization of the mother.
This changed in the 1980s, when evidence began to emerge that the hormonal and cellular changes characteristic of pregnancy exert protective immunomodulation of the disease, particularly in the third trimester.
It is also now known that his disease does not affect fertility and does not pose any risk to either the mother or the fetus. Additionally, biochemical and molecular changes during pregnancy mean that women feel better physically and mentally during this stage.
On the other hand, the degenerative effects of multiple sclerosis tend to be worse in the mother after childbirth, with a higher risk of disease flare and greater physical impairment one month after delivery (at least 0.5 point worsening in the expanded disability status). Scale).
Fears and hopes
We recently published a study examining how women with multiple sclerosis experience their pregnancies.
Obviously, the diagnosis influences the decision to become a mother. The disease does not eliminate the desire to try, but the physical and psychological symptoms encourage them to put health first. Although they are advised by a neurologist to become pregnant, their families are concerned about the consequences this may have on their physical and emotional well-being.
If they choose, they will prefer to face pregnancy while they are in the stable phase of the disease and before its development can complicate or prevent it.
Couples are also considering alternatives such as adoption or artificial insemination. The information provided by specialized medical personnel gives them peace of mind and confidence in achieving the desired pregnancy, dispelling the fear of a disease outbreak or counseling about possible malformations and health problems of the fetus.
Subsequently, the moment of delivery raises the usual concerns for expectant mothers with multiple sclerosis: pain during labor, use of epidural analgesia, and fear of a large perineal tear or complications requiring a cesarean section.
On the other hand, women suffering from this disease usually do not breastfeed, either because the information they receive about the compatibility of their treatments is usually inconsistent or because of the belief that they may pass toxicity to their infants through mother’s milk.
Biggest concern
However, as we have seen, their greatest concern is the possibility of disease outbreaks that will worsen their physical and mental well-being and may prevent them from raising their children and providing the care they need.
They understand that multiple sclerosis may limit their role as a mother: dressing the child, holding him, carrying him… And they are afraid to imagine a future with restrictions that prevent them from sharing moments of play. or leaves, leaving them virtually unable to reproduce.
Despite this, more and more people are embarking on this adventure. And to ensure they do so safely and confidently, nurses and midwives play a fundamental role in monitoring pregnancies with the best available scientific evidence at their fingertips.