Motherhood and multiple sclerosis (MS) have had a complicated relationship for quite some time. Readers who were diagnosed decades ago may remember when women with MS were advised to reconsider having children because of the stresses that pregnancy, birthing, and childrearing might put on them.
Over time, the prevailing advice changed to more of a “do it now, while you still can” line of thinking.
Today, thanks in part to organizations like the National Multiple Sclerosis Society, much more information is available for women with MS who are considering becoming pregnant, so they can make an informed decision about starting or adding to a family.
Now, a new study adds to the body of knowledge about MS and pregnancy, and it shows an elevated risk of mental health complications around pregnancy for women with MS.
Study Measures Mental Illness During Pregnancy
Published in Neurology, the study followed almost 900,000 Canadian woman through pregnancy: 1,745 of the women had MS, 5,954 had epilepsy, 4,924 had inflammatory bowel disease, 13,002 had diabetes, and 869,227 had no diagnosed chronic condition (the controls).
Researchers found that the women with MS not only outpaced the controls in terms of experiencing any incidence of mental illness — they also outpaced the three other chronic illness comparisons as well. Among mothers with MS, 8.4 percent of them experienced some form of mental illness prenatally, and 14.2 percent had it during the first postpartum year.
The most common challenges these mothers with MS experienced were depression and anxiety. But the rates of all mental illness measures were increased in the MS cohort, except for suicide attempts. These elevated mental illness rates were shown both during pregnancy and in the year after giving birth.
Of particular concern to the researchers were elevated rates of substance use or abuse by mothers with MS, which increased from 0.54 percent during pregnancy to 6 percent one year after giving birth.
A Need for Screening and Intervention
In an editorial on the subject, Lindsay Ross, MD, of the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic in Ohio, states that this elevation in incidence of mental illness around pregnancy in women with MS merits neurologists’ attention.
Of concern to the study’s authors, “Mothers with depression breastfeed for shorter periods, and their children receive less preventive care and undergo more emergency department visits.”
They further added that “Infants and older children may suffer from behavioral disturbances, developmental delays, and social withdrawal.”
Dr. Ross writes that “clinicians caring for women with MS should consider implementation of validated screening tools of peripartum mental illness and substance abuse” and “include regular discussion of mental health and substance use as part of family planning, pregnancy, and postnatal visits.”
More Work, but Worth the Effort
These recommendations will be a big ask of our already stretched neurological treatment resources. That being said, it’s another area where people with MS (in this case, women with the disease who are in the family planning stages of their lives) can take control of their care by driving these discussions with their healthcare providers.
It’s well-known that anxiety and depression often accompany multiple sclerosis. Now, another area of mental health challenges for people with MS has been uncovered, thanks to this new research.
As with so many other parts of our disease, forewarned can mean forearmed — and forearmed is being ready for the fight.
Wishing you and your family the best of health.
Cheers,
Trevis
