Multiple sclerosis and pregnancy

Key content Multiple sclerosis (MS) is a chronic neurological disease that manifests with clinical and subclinical attacks of central nervous system demyelination. Women are at least twice as likely as men to suffer from MS, with a mean age of onset of 30years. Pregnancy has no adverse long-term effect on disease progression, but it is associated with a higher relapse rate in the immediate postpartum period. Pregnancy can worsen pre-existing urinary/bowel dysfunction and motor problems. MS is not associated with significant obstetric or neonatal complications. Learning objectives To understand how to manage pregnant women with MS in the multidisciplinary setting. To understand the importance of pre-pregnancy counselling for women with MS who are on disease-modifying drugs. To understand the implications of pregnancy on MS symptoms and their management. To be aware of the benefits of breastfeeding and the safety of disease-modifying drugs and lactation. Ethical issues In the absence of clear guidelines, should women ever be advised to avoid pregnancy? Should women be offered in vitro fertilisation treatment, which is known to increase disease relapse?