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Psychosocial issues 

Psychosocial issues
Chapter:
Psychosocial issues
Author(s):

John Zajicek

, Jennifer Freeman

, and Bernadette Porter

DOI:
10.1093/med/9780198569831.003.0027
Page of

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date: 17 October 2019

Pregnancy 296

Vocational activities 298

Family issues 300

Children 302

MS and partners 304

Carers 306

The effect of pregnancy on disease activity is an important concern among young women. A prospective study of pregnancy in MS confirmed that relapse rate declines during pregnancy, especially in the third trimester, increases during the first three months post-partum, and then returns to pre-pregnancy rate. In the same study epidural analgesia and breast feeding did not increase the risk of relapse. There is therefore no medical contraindication to pregnancy in MS. Women should be encouraged to seek medical advice before conception in order to review any medications and make changes as necessary. None of the disease modifying drugs are considered safe during pregnancy and should be stopped, ideally in advance of conception. Disease modifying drugs may be restarted following delivery if the mother does not plan to breastfeed, otherwise treatment can be resumed once breastfeeding is stopped. There are no contraindications to using analgesia including transcutaneous nerve stimulation or epidural pain relief during child birth....

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