44 msfocusmagazine.org Relapses during and shortly after pregnancy Theriskofrelapseisdecreasedinpregnancy, but not absent. Urinary tract infections are more common in pregnancy and can produce symptoms similar to a relapse, known as a pseudorelapse. Gadolinium contrast should be avoided during pregnancy, but MRI can be performed in pregnancy, if necessary. In the first trimester, steroids may slightly increase the risk of cleft palate (although recent studies have not found this association). In the second and third trimesters, steroids may increase the risk of preterm labor and lower birth weight, but are appear to be safe for the fetus. It is important to balance the risks and benefits of treating a relapse, and your neurologist should help you chose the safest approach for you and your baby. Three to six months postpartum is a high relapse risk period. You will be tired from delivery, pregnancy, and the demands of having a new baby in the home. Here again, an individualized approach is essential, and you andyourneurologist should consideryour desire to breastfeed as well as your risk of a relapsewhen developing a plan. Breastfeeding is best foryour babyand somewomen maybe effectively protected from relapse by exclusive breastfeeding, while others may benefit from early treatment initiation although the data are not clear on this yet. All women should be monitored very closely in the postpartum period. Some neurologists, to tryto decrease the risk of post-partum flares, have used steroids and/or Intravenous Immunoglobulin. Delivery and breast feeding Apart from any specific mobility or balance issues, women with MS do not require any particular changes in the usual individualized managementofpregnancy.Ingeneral,pregnant women with MS are at slightly higher risk of high blood pressure during pregnancy and the rates of forceps and/or vacuum assisted delivery and cesarean section are also slightly higher. Epidural and spinal anesthesia appear to be safe for women with MS, and there is no evidence suggesting an increase in the risk of relapse. Children of women with MS may have slightly decreased birth weight but are otherwise healthy. We suggest pumping and discarding breast milk for a few hours after treatment with high-dose steroids, such as those used for the treatment of a relapse. Less than 0.1 percent of gadolinium enters breast milk, however, we recommend that patients pump and discard for 24 hours after an MRI, substituting formula during that time. Conclusions • WomenwithMScansafelyundergopregnancy and deliver babies • Family planning is important and should be discussed with MS specialist regularly so that appropriate and safe treatment plan can be put in place • There is an increased risk of relapses in the postpartum period. The decision to breast- feed orto return to prepregnancyMS therapy should be individualized. Life With MS What do you wish you had known about MS when diagnosed? Lily Richards: I wished I would've known that it's okay to have a new "normal." Just because we are different doesn't make our lives worthless. Even on our worst day, we are truly blessed. We don't have to compare ourselves with other MSers and non-MSers. We are uniquely made.