The objective of this pilot study is to improve prenatal counseling by understanding how specific domains of multiple sclerosis (MS) symptoms are affected by pregnancy.

MS often affects women of childbearing age.  While a wealth of literature examines MS relapse rates during pregnancy, the authors are unaware of any studies investigating the impact of pregnancy on specific symptom domains.  Such targeted investigations may help us to better understand the physiology of the effects of pregnancy on MS.  Moreover, we may gain insight into which specific hormonal or physiological changes can improve symptoms in all MS patients.

Eleven MS patients were asked about their prior pregnancies. They rated the severity of their symptoms before, during, and after pregnancy using the Multiple Sclerosis Rating Scale-Revised for the following domains: walking, using arms, vision, bowel/bladder control, thinking/memory/cognition, and numbness/tingling/pain. Data about 18 pregnancy encounters were compiled.

All patients had symptoms at baseline, and all of the following observations compare symptoms during pregnancy to pre-pregnancy baselines. Total symptom burden decreased in 66% and stayed stable in 16% of encounters.  On average, cognitive and sensory symptoms improved the most, with complete resolution during pregnancy in half of all encounters.  On average, symptom burden decreased in every domain except bowel/bladder control: increased bowel/bladder symptoms were seen in 4 of 18 encounters (22%), and 3 of these increases persisted postpartum.

While the majority of pregnancy encounters experienced improved symptoms (particularly in sensory and cognitive domains), surprisingly, bowel/bladder symptoms increased during pregnancy and typically persisted postpartum. Larger studies should be performed to determine whether these results are reproducible. To better understand whether increased bowel/bladder symptoms are related primarily to structural changes caused by pregnancy or to increased autoimmune activity, future investigations should compare the symptom burden of MS patients to that of healthy control patients.