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Ankylosing Spondylitis and Pregnancy

Here’s what you should know if you are pregnant, planning to become pregnant or are breastfeeding.

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For a woman considering pregnancy, some questions are universal – will I have severe morning sickness? Should I have natural childbirth or get an epidural? Will I use cloth diapers or disposables?  But if you have ankylosing spondylitis (AS) you probably have some unique ones – will my disease or medication affect my baby’s development? Will my symptoms worsen during pregnancy? Will arthritis affect my delivery? Will I be physically able to care for my new baby?

In most cases, the answer to these questions can be quite reassuring, says Mehret Birru Talabi, MD, PhD, assistant professor of medicine in the University of Pittsburgh’s Division of Rheumatology and Clinical Immunology.

Here’s what you should know about common concerns when you’re thinking about having a baby, during pregnancy and after the delivery.

Pregnancy Planning

There is no evidence that having ankylosing spondylitis will affect your ability to conceive. But pre-planning is important, so practice effective birth control until you decide the time is right for you to have a child.

Ideally, you should discuss family planning issues with your rheumatologist early on, not just when you’ve decided you would like to start trying to have a baby, says Lisa Sammaritano, MD, associate professor of clinical medicine in the Division of Rheumatology at Hospital for Special Surgery – Weill Cornell Medicine.

Effect of ankylosing spondylitis and medications on baby. Planning will always involve a discussion of which medications you can and can’t safely continue during pregnancy. Methotrexate is one drug used in AS treatment that should always be stopped before attempting pregnancy, due to its effects on fertility and possible risk of birth defects.

Fortunately, says Dr. Sammaritano, the risks of most drugs prescribed for AS end when the drug is out of your bloodstream. Neither the drugs you took in the past nor AS itself should affect the development of your baby.

Passing on AS. There is a genetic component to autoimmune diseases, such as AS.  While there’s a possibility that your child may develop AS or another autoimmune disease, it’s 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. 

Disease activity during pregnancy. Similarly, having a baby will not likely have a significant impact on the course of your AS. Research dating back to the late 1990s suggested that women with AS have a roughly equal chance of having their disease activity worsen, improve or stay the same during pregnancy.  A 2018 study published in Rheumatology found that for women with AS, disease activity tended to stay low and stable throughout most of pregnancy with disease activity peaking in the second trimester.

Caring for new baby. A study published in the Journal of Fetal and Maternal Medicine in 2016 found that for about one-third of women AS flare in the months after delivery, which could mean you’ll need some extra help caring for your baby if that happens. “It’s important that women who are considering pregnancy also consider their support systems and get those support systems in place during their pregnancy and after they deliver,” says Dr. Birru Talabi.

Pregnancy: The Whole Nine Months

If the drugs you were taking at conception are controlling your disease, your doctor will likely have you continue them throughout pregnancy, provided they are pregnancy compatible.

AS’s effect on delivery. If arthritis affects your back or hips, you may notice more pain in those joints as your baby grows and places more stress on those joints. Ask if your obstetrician has experience working with women with disabilities. If possible, find out the same about the anesthesiologist who will be working with you in the delivery room. In some cases, involvement of the hips and spine could make a vaginal delivery more difficult and inflammation of the spine could make it difficult to administer an epidural – the injection of an analgesic directly into space around the spinal cord to numb the lower half the body during delivery.  You should discuss these possibilities with your doctor.

If disease becomes more active during pregnancy or you develop any complications you should speak with your OB/GYN about a referral to high-risk OB/GYN. However, a 2016 study in the Journal of Maternal-Fetal & Neonatal Medicine found no increase in adverse pregnancy outcomes in women with AS.

Planning for your newborn’s care. During pregnancy it’s important to plan for the help you’ll need after you deliver. Even if your disease is well controlled you may have more fatigue than other new mothers, so you’ll likely need extra help once the baby comes.

Ability to breast feed. There’s no evidence that AS lowers milk production. However, some women experience pain when trying to hold their babies to breastfeed, especially if their AS is not well-controlled. While you can’t pass AS to your child by breastfeeding, you can pass along some medications. Many medications are safe to use in lactation, and medication passage through breastmilk is relatively low in many cases.

After Delivery

For most women with AS a healthy delivery and baby is possible.

Disease activity. If you notice worsening of symptoms, contact your rheumatologist, because a flare is more likely in the months after delivery. And even if your disease is stable, childbirth and caring for a newborn is exhausting, so fatigue is likely.

Medication and breast feeding. If controlling your disease after delivery requires a change in medication, let your doctor know if you are breastfeeding. Many medications, but not all, are safe for breastfeeding.

Caring for baby. Taking care of yourself now is especially important – take your medications, eat healthfully, nap when the baby naps and get help from your partner, trusted family and friends and even paid help, if needed or possible. Parenthood is a challenging, lifelong job, but may provide unique joys. Taking care of yourself now can help ensure your ability to care for your child in the years ahead.

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