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Rheumatoid Arthritis and Pregnancy

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

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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 rheumatoid arthritis (RA) 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.

Planning for Pregnancy

Research suggests that some women with RA have more difficulty conceiving than women without the disease, yet you always assume you are fertile until you have been evaluated by a physician, says Dr. Birru Talabi.

Pre-pregnancy planning is important and should involve both your rheumatologist and OB/GYN, says Dr. Birru Talabi.  “We know that many women who have well-controlled RA have healthier pregnancies and babies than women who have really active disease at the time they become pregnant.” Ideally, RA should be controlled for 3 to 6 months before attempting pregnancy. Women who have uncontrolled rheumatoid arthritis may be at increased risk of complications such as preterm birth and babies that are small for their gestational age. This may increase the likelihood that the baby requires more medical care early in life.

Effect of RA and medications on baby. Because controlling RA typically requires disease-modifying antirheumatic drugs (DMARDs), there’s a role for safe DMARD use before and during pregnancy, says Dr. Birru Talabi. However not all DMARDs are safe. Methotrexate, for example should be stopped at least three months before pregnancy because of its potential to cause birth defects. Other medications should be discussed with the rheumatologist, and the individual risks and benefits should be weighed. 

Passing on RA. While there’s a possibility that your child develops RA 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. Disease control may be easier when you are pregnant. A review of studies published in the March 1, 2019, issue of the Journal of Rheumatology found that disease activity improved in 60% of patients with RA in pregnancy and flared in 46.7% postpartum. Doctors believe this is due to hormone changes and immune system changes that protect the unborn baby and are also beneficial to RA.

Caring for new baby. There’s a possibility that you may experience a flare after delivery and experience a lot of fatigue. “So, it’s important that women who are considering a pregnancy also consider their support systems and make sure they are in place before 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.

RA’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. Unless you have joint deformities in your pelvic region, RA should not affect your ability to have a normal vaginal delivery, says Dr. Talabi.  While Cesarean delivery doesn’t appear to be more common in women with RA, research shows that high disease activity during pregnancy  increases the risk for pre-term, low birthweight babies and the need for a Cesarean delivery.

If disease becomes more active during pregnancy or you develop any complications speak with your current OB/GYN about a referral to high-risk OB/GYN.

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 RA lowers milk production, says Dr. Birru Talabi. However, some women experience pain when trying to hold their babies to breastfeed, especially if their RA is not well-controlled. While you can’t pass RA 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 RA, a healthy delivery and baby is possible.

Baby’s health. Having RA does not mean health problems for your baby – including RA. Inheritance isn’t 100 percent, says Dr. Birru Talabi. “That is, just because a woman has RA doesn’t mean her children will have RA.”

Disease activity. If RA improved during pregnancy it may flare in the weeks or months after delivery as hormones and the immune system return to their pre-pregnancy state.

Medication and breast feeding. If you had a reprieve from your RA during pregnancy you may be experiencing more joint pain now. It’s important to work with your rheumatologist to ensure control of your disease. If this requires a change in medication, be sure to 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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