Inflammatory Arthritis and Pregnancy
Learn how your condition may affect the different stages of pregnancy.
The decision to have a baby is one of the most important ones a couple will make. For a woman with arthritis, the decision might raise some questions: Will the disease or its treatments affect her baby? Will having a baby affect her arthritis? Will arthritis affect her delivery? Will she be able to care for her newborn?
Arthritis could affect pregnancy from conception to the weeks or months following birth. And pregnancy can make a difference – either good or bad – on a mother’s arthritis. But predicting the course of pregnancy and how it may affect arthritis symptoms isn’t possible. But the good news is that, armed with knowledge and a strong health care team, most women with arthritis and related conditions can have healthy pregnancies.
There is a genetic component to many autoimmune diseases, so your child may be somewhat more likely to develop an autoimmune disease, although not necessarily the one that you have. However, it is really important to remember that many women with autoimmune diseases have healthy babies who don’t develop arthritis or any other type of autoimmune disease.
Here’s what you need to know about pregnancy from the planning stages to delivery and beyond.
Planning for Pregnancy
Pre-pregnancy planning is important and should involve both your rheumatologist and OB/GYN, says Mehret Birru Talabi, MD, PhD, assistant professor of medicine in the University of Pittsburgh’s Division of Rheumatology and Clinical Immunology. For the best possible outcome your disease should be well controlled 3 to 6 months before trying to conceive, she says.
For most women, controlling arthritis requires medications, so talk to your doctor about your options. Methotrexate and leflunomide should be stopped before pregnancy, because they can cause miscarriages and birth defects. These drugs can also affect sperm cells, so if your partner is taking one of these drugs it’s important that he stops.
Also, talk to your doctor about the potential effect of your disease on pregnancy and delivery and whether you need a high-risk OB/GYN.
Lupus, scleroderma and Sjogren’s syndrome are associated with autoantibodies (immune proteins) that can affect your baby. Any risks can be managed with careful planning and care throughout pregnancy from a high-risk OB/GYN. Other autoimmune diseases, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) don’t carry the same autoantibody risk to the unborn child.
Disease activity during pregnancy will depend on several factors including the type of arthritis you have. Studies on women with RA, PsA and AS have shown that pregnancy can cause improved, stable or worsening disease activity during any of the trimesters.
Regardless of arthritis type, joint pain and fatigue can affect pregnancy and child-rearing. Think about the support you’ll need – a caring partner, supportive family members and friends as well as financial resources to hire help.
If your medications are controlling your disease, your doctor will likely have you continue them throughout pregnancy, with at least one exception. Nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen should not be taken during the third trimester, as NSAID use could prolong labor and lead to pulmonary hypertension (high blood pressure in the arteries to lungs) in your baby.
The added stress of pregnancy may worsen fatigue. If you have back pain, your growing belly may worsen symptoms. Increasing weight places more stress on weight-bearing joints.
If your disease affects your spine or hips, check whether your OB/GYN has experience working with women with arthritis. If possible, find out the same about the anesthesiologist who will be working with you in the delivery room, should you need a C-section or pain medication during vaginal delivery.
It’s important to plan for the help you’ll need after you deliver. Fatigue affects many new mothers. Even if your disease is well controlled, you may still a lot of fatigue. If you’d like to breastfeed, arthritis shouldn’t affect your ability to do so. While you can’t pass arthritis along to your child by breastfeeding, you can pass along some medications, so it’s important to speak with your doctor about drugs that are safe. New research has shown that some biologics have very minimal transfer from placenta to baby and from mother-to-infant transfer through breast milk.
The days after giving birth are some of the most exciting, but exhausting, days of a woman’s life.
If your disease was quiet during pregnancy, you may begin to experience more joint pain, stiffness and fatigue. It’s important to work with your rheumatologist to ensure control of your disease while continuing medications that are safe for your baby if you plan to breastfeed for as long as possible.
Taking care of yourself as a new mother is especially important – take your medications, eat healthfully, nap when the baby naps, ask for help and take care of your emotional health.