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Sjögren’s Syndrome and Pregnancy

Know the facts before becoming pregnant.

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The nine months of pregnancy can be among the most exciting of any woman’s life. But for women with Sjӧgren’s syndrome the excitement can be tempered by concerns related to her disease: Will Sjӧgren’s affect my baby’s development? Will being pregnant make my Sjӧgren’s worse? Will Sjӧgren’s complicate my delivery or affect my ability to breast feed or take care of my child? 

While a diagnosis of Sjӧgren’s can certainly bring challenges to pregnancy and childbirth, being prepared and getting the proper medical care along the way can help ensure the  best possible pregnancy outcome, says Lisa Sammaritano, MD, associate professor of clinical medicine in the Division of Rheumatology at Hospital for Special Surgery – Weill Cornell Medicine.

Here is what you need to know about pregnancy from the planning stages to delivery and beyond.

Planning for Pregnancy

There is no evidence that having Sjӧgren’s syndrome will affect your ability to get pregnant, so it’s important to 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 Dr. Sammaritano.

Effects of medications on baby. Planning will always involve a discussion of which medications you can and can’t safely continue during pregnancy and finding alternatives for those you can’t. Planning will allow you and your rheumatologist to make sure disease activity is low while on pregnancy-compatible medications, says Dr. Sammaritano. “This process can take some time, since changing a medication means giving it several months to make sure that it working and that it does not cause side effects,” she says.  

Effects of Sjӧgren’s on baby. Planning should also include an evaluation of factors that could make pregnancy riskier for you and your unborn baby including the presence of two autoantibodies, anti-Ro (SSA) and/or anti-La (SSB), which are common in Sjӧgren’s.  In rare cases, the antibodies are associated with congenital heart block, an abnormality of the rate or rhythm of the baby’s heart, which can begin in the womb.

Because of the increased risks that can come with Sjӧgren’s syndrome it will be important to see a high-risk OB/GYN as well as your rheumatologist. You may be also need to see doctors to monitor and manage other aspects of your disease.

Passing on Sjӧgren’s. There is a genetic component to autoimmune diseases, such as Sjӧgren’s.  While there’s a possibility that your child may develop Sjӧgren’s or another autoimmune disease, it’s really important to remember that many women with autoimmune diseases have healthy babies who don’t develop Sjӧgren’s or any other type of autoimmune disease. 

Effect of pregnancy on Sjogren’s. For many women, Sjӧgren’s syndrome worsens during pregnancy and/or after delivery. This makes it important to not only see your rheumatologist regularly but to also to plan for extra help after the baby comes.

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 compatible with pregnancy.

Monitoring baby. If you tested positive for anti-SS-A, your doctor may want to monitor your baby by fetal echocardiogram, a procedure that uses ultrasound waves to view the action of the heart as it beats. 

Effects on delivery. While most women with Sjӧgren’s syndrome can deliver vaginally, any complications with your or the baby could necessitate an early delivery by C-section.

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 breastfeed. If you’d like to breastfeed, speak to your doctor about medications that are safe during breastfeeding. While most women with Sjӧgren’s can breastfeed, in some cases the disease can interfere with milk production, making bottle-feeding or supplementing with a bottle a better option.

After Delivery

For most women with Sjӧgren’s syndrome a healthy delivery and baby is possible.

Disease activity. If you notice worsening of symptoms, contact your rheumatologist, because some women experience increased disease activity after delivery. And even if your disease is stable, childbirth and caring for a newborn is exhausting, so fatigue is a given.

Medication and breast feeding. If controlling your disease after delivery 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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