Ending a Pregnancy When You Have Arthritis

Pregnancy raises potentially serious risks for women with rheumatic diseases and for developing babies.  

By Linda Rath | July 29, 2022

Women with rheumatic diseases, like lupus or rheumatoid arthritis, have a concerning number of unplanned pregnancies, despite the risks their disease and medications may pose, according to research. Yet there are no data-based guidelines to help doctors who care for them.

Although pregnancy can be riskier for women with rheumatic diseases, they have about the same rate of abortions as the general population. This suggests similar rates of unplanned pregnancies, even though these can be dangerous for both mother and fetus.

“These findings are concerning, as unplanned pregnancies in these patients could lead to adverse maternal and fetal outcomes,” wrote the authors of a Canadian study of more than 2,500 women with lupus.  

Abortions do not seem to be associated with worsening disease or complications, but both pregnancy and certain medications taken for the disease are. Pregnancy is especially risky for lupus patients who have heart, lung or kidney disease or a history of life-threatening high blood pressure called pre-eclampsia. When these conditions are severe, doctors may recommend ending the pregnancy.

Reasons for Abortion

Pregnant women with autoimmune disease end a pregnancy in most cases due to serious health risks to themselves or the fetus, in some cases because they take the arthritis drugs methotrexate, mycophenolate mofetil or thalidomide, which cause birth defects.

Despite this, researchers see some concerning trends, especially with lupus and pregnancy. For example, a 2021 study found that women who have lupus had abortions at about the same rate as other women — and women with lupus who took drugs known to cause birth defects had fewer abortions than those who didn’t take them.

patient consulting with doctorNo Guidelines

The American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) have extensive reproductive health guidelines, covering everything from family planning to in vitro fertilization (IVF). But there are no evidence-based guidelines for ending a pregnancy. To try to identify and potentially fill those gaps, Canadian researchers looked at factors that health care providers should consider when advising patients about abortion. The study was published December 2021 in Arthritis Care and Research.

What You Should Know

If you decide to end a pregnancy, it’s important to know the different options, their safety and effectiveness as well as potential risks and complications.

Medication Abortions

In 2020, more than half of all elective abortions were through medication or pill abortions. Demand for these pill abortions has surged since the Supreme Court’s ruling that put abortion legislation in the hands of states. Some women choose pill abortions because they’re noninvasive, private and don’t require several visits to a doctor. In some states, they may now be the only option. Pill abortions are safe for most women in the first 70 days of pregnancy. They’re 98% effective in the first eight weeks of pregnancy. At nine and 10 weeks, they’re 96% and 93% effective, respectively.

The most common pill regimen uses two drugs — mifepristone and misoprostol. Mifepristone is a synthetic steroid that binds to the same receptors as corticosteroids, making them less effective. Be sure to let your doctor or pharmacist know you’re on corticosteroid treatment before taking mifepristone. Your doctor may advise against a mifepristone regimen or temporarily increase your corticosteroid dose. You shouldn’t use mifepristone if you have chronic adrenal failure.

The other medication regimen uses a combination of methotrexate and misoprostol. Methotrexate is not an option if you have liver or kidney disease or bone marrow problems. Also, there are no guidelines on what to do when a patient who takes methotrexate for an inflammatory disease also needs it to end a pregnancy. Patients in some states that have abortion bans have reported having trouble getting their methotrexate prescriptions refilled, and some pharmacies in those states are now requiring the prescriber to identify the condition it’s being prescribed for.

Pill abortions aren’t recommended if you take blood thinners, like warfarin, or have severe anemia or thrombotic antiphospholipid syndrome (APS), a blood clotting disorder that affects some people with lupus. The risk of hemorrhage with pill abortions is eight times higher than for surgical abortions.

Surgical Abortions

Surgical abortions can safely be performed in the first and second trimesters and are 98% effective. They cause fewer complications than abortion pills and take less time — 10 to 30 minutes instead of about 24 hours. There’s little risk of infection with surgical abortions, though it’s not known if the risk is higher in immunocompromised people. Surgical abortion is now banned completely or partially in a number of states. 

Preventing Unplanned Pregnancies

Studies show that nearly 60% of people with rheumatic conditions didn’t receive birth control counseling in the last year, and more than half used unreliable barrier methods like condoms and diaphragms. Yet effective birth control is essential when pregnancy poses risks for both mother and fetus. The best choice for people with rheumatic conditions is a reversible, long-acting method such as an intrauterine device (IUD) or progestin implant. These methods are 99% effective, resulting in one unplanned pregnancy for every 100 women. It can be intimidating to talk to your doctor about birth control, but it’s important to discuss, especially for women with rheumatic condition who are of child-bearing age.

I Want to Contribute
I Need Help
  • Donate

    Donate

    Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life.

  • Volunteer

    Volunteer

    Join us and become a Champion of Yes. There are many volunteer opportunities available.

  • Live Yes! INSIGHTS

    Live Yes! INSIGHTS

    Take part to be among those changing lives today and changing the future of arthritis.

  • Partner

    Partner

    Proud Partners of the Arthritis Foundation make an annual commitment to directly support the Foundation’s mission.

Donate


Ways to Give

Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life. Whether it is supporting cutting-edge research, 24/7 access to one-on-one support, resources and tools for daily living, and more, your gift will be life-changing.

Make a Donation

Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Please, make your urgently-needed donation to the Arthritis Foundation now!

Become a Member

Become an Arthritis Foundation member today for just $20 and you'll receive access to helpful tools..... and more. 

Make a Honor or Memorial Gift

Honor a loved one with a meaningful donation to the Arthritis Foundation. We'll send a handwritten card to the honoree or their family notifying them of your thoughtful gift.

Gift Planning

I want information on ways to remember the AF in my will, trust or other financial planning vehicles.
 

Volunteer


Volunteer Opportunities

The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.

Become a Volunteer

More About Volunteering

Live Yes! INSIGHTS


Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 

How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

Get Started

Partner


Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.

Trailblazer

Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

Visionary

Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

Pioneer

Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.

Pacesetter

Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.

Signature

Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.

Supporting

Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.