Chronic Fatigue Syndrome (CFS) usually affects women during their peak childbearing years. As a result, many women who are debilitated by CFS have to make the important and difficult decision on whether or not they should have a child. Younger women may be able to wait and hope for improvement before getting pregnant, but waning fertility is a concern for older women. Countless women with CFS have had successful pregnancies and healthy children. However, they often found raising their children to be extremely difficult. Both parents should be in agreement, because the child’s father will of necessity, have to do much more for both mother and child, than in families where the mother is healthy. Many CFS patients have various concerns about pregnancy. These concerns will be discussed in this fact sheet.
What effect does pregnancy have on CFS?
Research has found that in pregnant CFS patients, CFS symptoms improve
in approximately one third, are unchanged in about one third, and
worsen in about one third1. More mothers feel worse during
their second and later pregnancies2. Improvement during a
pregnancy usually occurs after the first trimester and is thought to be
due to the effect of pregnancy hormones. Mothers with CFS need extra
rest during pregnancy and some may need bed rest most of the time.
Within weeks of delivery, at least half of the mothers either relapse
or feel worse than before the pregnancy. Symptoms are similar both
before and after the pregnancy in about a third of mothers and symptoms
are decreased in a minority1. Relapse after delivery is
likely to be due to the extra effort needed to take care of a young
baby, coupled with the loss of the elevated pregnancy hormones.
Many CFS patients use both over-the-counter and prescribed medications to relieve symptoms. Some vitamins, such as folic acid, are beneficial both before and during pregnancy. In healthy women, folic acid has been shown to reduce the occurrence of neural tube defects in the child. However some medications can damage the fetus especially in early pregnancy. The effects of most herbal preparations are unknown. The CFS patient should discuss all her non-prescription and prescribed medications with her doctor, to identify potentially dangerous treatments, which should be stopped before pregnancy begins. CFS symptoms may worsen as a result of stopping the medications.
What effect does CFS have on the child?
There is a theoretical possibility that a virus, which might cause CFS, could be passed to the fetus during pregnancy or delivery, or to the child during breast-feeding and affect the child later in life. There is no scientific evidence for any of these scenarios. Most women with CFS have normal healthy children, but CFS in both mother and child does occur. A recent survey found that 5% of the children of mothers with CFS also developed CFS. Half of the affected children developed the disease as adults, and 42% of the children recovered3. Both genetic susceptibility and an infectious agent have been proposed as possible contributors to the risk of CFS in these children3.
No difference in the risk of birth defects was found in the children who were born before their mothers developed CFS, compared with the children born after their mothers developed CFS1. However developmental delays or learning disabilities were found to occur in more than twice as many children who were born after their mothers developed CFS, compared with children born before their mothers developed CFS1. Because of possible risks to the child, some parents have opted for adoption.
What effect does CFS have on pregnancy?
Pregnancy is not recommended in the early stages of CFS, when the woman is very ill, the diagnosis is uncertain and a possible infectious agent, which might be the cause of CFS, may be actively multiplying.
Infertility occurs in 10% to 20% of normal couples. It may be more frequent in CFS patients because many have problems, which reduce fertility, such as irregular periods, Endometriosis, or lack of libido.
First trimester miscarriage occurs in 10% to 20% of pregnancies. The miscarriage rate was higher, around 30%, in two groups of women with CFS1,4.
A common symptom of early pregnancy is morning sickness, which usually improves after the first trimester. In women with CFS, this symptom may be more severe, lasting throughout the day and even persisting into the later months of pregnancy5. The severe form of morning sickness, hyperemesis gravidarum, was also found to be more common in pregnant CFS patients than in normal women. For morning sickness, bed rest helps. Complementary therapies such as fresh ginger or Sea-bandsTM worn around the wrists may be useful. Prescribed medications are sometimes necessary.
Other pregnancy complications including vaginal bleeding, gestational diabetes, hypertension, pre-eclampsia, premature rupture of membranes, premature labor and low birth weight of the baby were found to be no more frequent in the pregnancies of CFS patients, whether the pregnancy occurred after or before the patient developed CFS1.
Prenatal care should start early in pregnancy. An ultrasound scan should be done to confirm the fetal age and the date of delivery and to reassure the parents of the presence of a fetal heartbeat.
What effect does CFS have on labor and delivery?
A mother with CFS may tire more quickly in labor than other mothers. If she also has fibromyalgia, which is a common co-illness in CFS, labor pain may be experienced as being more intense than normal. Adequate pain relief is very important. An epidural anesthetic can be useful. Prolonged labor can be avoided and the baby delivered before exhaustion occurs by using a C-Section in the first stage of labor, or using forceps or a vacuum extractor in the second stage. A C-Section before labor may be recommended. C-Sections require an epidural or a general anesthetic. Many women with CFS require a much smaller dose than normal, of both drugs given for pain relief in labor and drugs used for epidural and general anesthetics. Mothers with CFS should be kept well hydrated in labor.
What effect does CFS have after delivery?
Many women with CFS are exhausted by childbirth and need to stay in the hospital longer than normal. Arrangements for this possibility should be made before delivery. A C-Section is a surgical procedure and requires extra time for recovery. Postpartum depression is two to three times more frequent in CFS patients than in healthy mothers6. The new mother may respond to supplemental hormones as well as to antidepressants7. Previously healthy mothers can develop CFS after delivery. This occurred in 3.5% of a large group of CFS patients8. Their CFS could have been triggered by the effect of changing hormone levels on the immune system.
CFS and Breast Feeding
Many mothers with CFS successfully breastfeed their babies and it is a lot less trouble than preparing formula. Some mothers even feel better while they are breastfeeding. Other mothers find nursing their babies is exhausting and for them, someone else can help with bottle-feeding. Mothers should weigh the well-known benefits of breastfeeding against unproven risks of exposing their infant to a possible CFS infectious agent in breast milk.
Many women feel better during pregnancy, but they relapse after delivery. If so, previously helpful CFS medications may be beneficial. Bottle-feeding is recommended if these are medications that pass into the breast milk and could adversely affect the child.
Coping with Child Rearing
Having a child is usually very rewarding, but taking care of an infant - and later on a toddler - is hard work. When the mother has CFS, childcare can be difficult and very exhausting. Both parents will suffer problems that other families do not face. Having a good support network is essential. Advice on how to cope can be obtained from other mothers in a local support group. CFS can discourage some women from having children. A recent survey found that 21% of a group of CFS patients decided not to have a child because they thought that their debility would interfere with their ability to raise their child1.
References
1 Schacterle S, et al. Arch Intern Med. 2004;164:401-404.
2 Walker C. http:/www.survey2002.org.uk. (Accessed 9-06).
3 Underhill R, et al. J Chronic fatigue syndrome 2005;13(1): 3-13.
4 Ginsburg KS, et al. Arthritis and Rheumatism 1992;35(4):429-33.
5 Jessop C. The CFIDS Chronicle. Spr. 1991:71.
6 Studd J, et al. Lancet 1996; 348:1384.
7 Gregoire AJ, et al. Lancet 1996;347:930-33.
8 De Becker P, et al. J Chronic fatigue syndrome 2002;10( 2):3-17.
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