A recent study printed in the April 2006 issue of Arthritis & Rheumatism found that lower birth rates among women with RA might partially be the result of women’s choices to limit family size. The researchers conducted a survey of women with RA to study childbearing decisions relative to age of diagnosis and stage of family development.

Over the years, some studies have shown that women with RA have a higher prevalence of having never given birth than the general population, and that women with RA tend to have fewer pregnancies than the general population. Other studies have contradicted those results. The authors of the study recognized that the research history suggests that there may a genetic component to infertility, but the research suggests that women make conscious decisions about having a family based on disease activity, the possibility of future disability, potential harmful effects of drugs on the fetus and potential issues in coping with a family in addition to RA.

The study found that 91 percent of the women surveyed reported at least one pregnancy and
85 percent reported at least one live birth. The study also found that women who were diagnosed at or before the age of 18 had fewer pregnancies and fewer children. Also, women who were diagnosed with RA prior to the birth of their first child had the fewest number of pregnancies and children, and women diagnosed at 45 or older or after all of their children had reach 18 years of age had the most pregnancies and births.

Few women reported being advised by doctors to limit family size. But of those who had, 20 percent said that having RA affected their decisions to have children or to limit family size. 32 percent of women who were diagnosed at 18 or earlier and 12 percent of women who were diagnosed between 19 and 44 reported being advised to limit family size. Over half of the women diagnosed at or before 18, and a third of the women diagnosed between ages 19 and 44 reported that RA had affected their decisions. Similar results were reported for women who were diagnosed before the birth of their first child or after the birth of the first child but before the birth of their last child.

The most commonly reported factor affecting childbearing decisions were concerns about being able to care for the child because of factors, such as fatigue and functional limitations. Similarly, fears of stopping treatment and fears of harmful effects of medication on the baby were commonly reported. The third most commonly reported factor was the fear of passing RA on to the child.

This study interests me, because even though I’m still single and not ready yet for children, it is something that I think about for the future. This study did not take into consideration a family history of autoimmune disorders as a factor for childbearing decisions. The women on my mother’s side have a strong genetic history of autoimmune disorders of all types (me and my sister, my mother and her only sister, my maternal grandmother and at least two of her six sisters, that I know of). In fact, one rheumatologist exclaimed, “God, what I wouldn’t give to do a genetic study on your family!” the first time he read my medical history. That wasn’t a great first impression for me.