Wondering if rheumatoid arthritis (RA) and pregnancy are compatible? The very welcome news is that they typically are. Moms-to-be with well-controlled RA are as likely to have a healthy pregnancy and baby as those without the condition.
And the even better news? Many expectant moms find that their RA symptoms improve during pregnancy.
How will pregnancy affect my rheumatoid arthritis and vice versa?
Rheumatoid arthritis (a condition in which a person's immune response attacks healthy tissue and organs) isn't likely to affect your pregnancy very much, but pregnancy may affect your RA — often for the better. Approximately 50 to 80 percent of women with rheumatoid arthritis notice an improvement in the pain and swelling in their joints as pregnancy progresses. The remainder typically have similar to pre-pregnancy symptoms, and rarely, women have RA flares during pregnancy.
Improvements in RA symptoms typically start in the first trimester and last through delivery. However, it’s not uncommon for new moms to experience flare-ups during the first three months postpartum. One study of new moms with RA found that 39 percent had at least one moderate flare-up after delivery.[1]
Doctors and researchers aren't exactly sure why your symptoms often get better during pregnancy. Your immune system goes through a lot of changes when you're expecting, and pregnancy lowers your immune response to keep your body from rejecting the fetus as "foreign."
That may have the added benefit of tamping down your haywire immune system, which in turn lowers the inflammatory response that causes the pain of RA.
How can I manage my condition during pregnancy?
The greatest change you may experience while you’re pregnant is in your treatment of RA. The reason: Some of the medications used to manage the condition are not safe to continue during pregnancy.
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You should discuss your medications with your primary care doctor or OB/GYN even before you become pregnant, since some medications (especially methotrexate) should be stopped before conception.[2] They may refer you to a maternal-fetal medicine specialist.
The decision about what medications to take and which ones to stop will depend on several factors, including how active your symptoms are during pregnancy. In some cases, your doctor may be able to switch you over to treatments that are safer for your baby or reduce the amount of medicine you're taking.
Some prescription medications, including methotrexate, leflunomide (Arava), and cyclophosphamide (Cytoxan) are not safe at any time during pregnancy because they may increase the risk for birth defects. Other medications, including aspirin (regular, not baby aspirin) and some non-steroidal anti-inflammatory drugs (NSAIDs), can be taken safely during some parts of pregnancy but not others.
Herbal remedies should be avoided completely, unless okayed by your prenatal practitioner.
Your practitioner may recommend a low-fat, high-carb, high-fiber diet, as well as extra calcium and vitamin D supplements, especially if you’re taking prednisone, which increases your risk of bone loss.
Does rheumatoid arthritis pose any risks to my baby?
Some studies show that certain medications used to treat RA — particularly high-dose steroids — can increase the risk of premature rupture of the membranes (when your water breaks before you’re actually in labor) and having a low-birth-weight baby. There's no evidence of a higher risk of stillbirth or miscarriage when you're pregnant with RA.
How will labor and delivery be affected by my rheumatoid arthritis?
During labor and delivery, it will be important to choose positions that don't put too much stress or strain on the affected joints. Talk to the physician who manages your arthritis — and your prenatal practitioner — about which positions might work best.
It's possible, though extremely unlikely, that you could end up needing a C-section if your RA makes it difficult to get into the proper position for a vaginal delivery.
The bottom line is that you've got a really good chance of having a perfectly healthy pregnancy and baby if you have rheumatoid arthritis when you get pregnant. Odds are also great that your symptoms will improve while you're expecting.
Just be sure to get the proper medical care and supervision, and as always, bring up any questions or concerns you have with your practitioner as your pregnancy progresses.
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