42 msfocusmagazine.org Although the majority of women with MS are diagnosed during their reproductive years, most of ourpatients are successful in achieving a happy, healthy pregnancy and are able to enjoy parenthood to the fullest extent. It is important to familiarize yourself with the effects of pregnancy on the course of MS, the effects of MS on the course of pregnancy, and the evidence regarding the use of disease- modifying medications in pregnancy. We ask our patients to inform us when they are considering pregnancy and dedicate an appointment to establishing an individualized pregnancy and MS treatment plan. This plan is different for every person and should take into consideration your preferences, age, the severity/aggressiveness of your MS, which DMT you take, and a number of other factors. Getting pregnant Persons with MS are considered to have normal fertility and most women with MS are able to conceive “the old-fashioned” way. However, the use of reproductive technology does appear to be slightly higher. Although large studies have not investigated the effects of assisted reproductive technologies on MS, smaller studies suggest an increased risk of relapsewith the use of gonadotropin-releasing hormone agonists. If you are considering assistive technology, it is important to review this information with your fertility specialist and neurologist. Effects of pregnancy on MS The Pregnancy in MS (PRIMS) study was the first large prospective study intended to understand the effect of pregnancy on the risk of MS relapses and progression. PRIMS found that a woman’s risk of relapse decreased from her baseline during pregnancywith the fewest relapses in the third trimester (Figure 1). However, therewas an increased risk of relapse in the first three months postpartum to nearly twice the baseline relapse rate. Pregnancy did not appear to affect the risk of progression. These results were replicated in several additional studies, although the relapse rates and magnitude of the postpartum rebound were lower than those seen in PRIMS. The protective effects of pregnancyon MS are likely consequent to hormone-mediated changes in the immune system, which becomes “less active”inpregnancy,andrelatively“moreactive” Life With MS Pregnancy and Multiple Sclerosis By Michael J. Bradshaw and Dr. Maria Houtchens Figure 1. Rate of relapse per woman per year for each 3 month period before, during and after pregnancy in the PRIMS study.