Many women who are diagnosed with MS during their 20s or 30s may be thinking about starting a family. Consensus guidelines on pregnancy in multiple sclerosis, developed by the UK Association of British Neurologists, is a useful reference document available online. Breastfeeding and pregnancy guidance from the MSBase Pregnancy Research group also provides a comprehensive summary of recent recommendations.

• What impact does MS have on pregnancy and having children?
  MS affects mainly women during their childbearing years and, as a result, impacts pregnancy, family planning and decisions about starting or extending a family.
• Planning for pregnancy
  This article discusses the effects of MS on fertility, decisions about starting or stopping a DMT, the use and safety of oral contraceptives and the possible impact of in vitro fertilisation on MS disease course.
• Concerns about parenting
  Being disabled or unemployed because of MS does not mean you cannot be a good parent. Here I cover some of these practical considerations as well as the steps you can take to reduce the potential risk of your child developing MS.
• Managing MS during pregnancy
  Opinion on how MS impacts pregnancy is based largely on data that predate the current era of active treatment and the newer generation of disease-modifying therapies (DMTs). In this section I have therefore addressed many of the important issues that women who are considering pregnancy need to understand.
• Preparing to give birth
  Some of the concerns that people with MS raise about giving birth are covered here, such as the possible need for assisted delivery, the likelihood of a normal vaginal delivery and the use of pain-relieving measures.
• Breastfeeding if you are on a DMT
  This section explains how relapse is managed during breastfeeding and provides detailed guidance on which DMTs are safe (or not safe) to use while breastfeeding.

Menopause is also a time when women with MS may need specific help to manage their disease. Whether you are going through menopause or planning pregnancy, please consult with your MS care team to make decisions about your ongoing treatment and lifestyle.

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