No, I'm not pregnant (Don't worry, Mom. You'd be the first to know). But before that, most people would ask who the guy is (Minor details, people, minor details). But the reality is, while I don't have a man or a baby, it's a topic that is at the forefront of my mind. Why? Well, because the way I figure it, if I'm 26, and I meet someone and date them for a year, and then we get engaged for a year, and then get married, and then I have to be off of meds for at least six months, by the time I'm (at the earliest) ready to have a baby, I'll be pushing 30 years old.
And by then, who knows? Will my drug battered body (specifically ovaries) have any juice left in them? Survey says...
About a year and a half ago, when I thought I had met the person who I truly thought was "the one," I went to my rheum, asking what pregnancy would look like for me. My rheum wasn't too happy with the "hypothetical" situation, but I wouldn't back down. I needed to know. And at the time, it didn't seem all that hypothetical. Basically, his response was that I would need to be off of all meds other than Prednisone, for at least six months. Now that presupposes the fact that I can actually get off meds and be able to function to some extent. I really wanted to give it a try. But my rheum would have none of that.
The reality is, while some women seem to go into spontaneous remission during pregnancy, some still have disease activity, and some end up with a severe flare after the baby is born (1,2). I'm not sure it's ever a simple decision to have a baby, but for women with RA and other autoimmune conditions, it's no simple matter. It probably ends up being one of the most planned, least spontaneous events in ones adult life.
The few things that are clear are: 1) You should be medication-free, other than
Prednisone basically, for at least six months, and possibly a year, before conception, 2) Any pregnancy where there are comorbidities of any kind is going to be high risk, and 3) Prednisone is the medication of choice during pregnancy, and I guess if you are going to be fat and moody anyway, might as well embrace it.
So that's the vague idea, at least for me, with the background that Methotrexate was used as an abortion drug in the 1950s and Quinacrine has been used for the forced sterilization of women in third world countries (3). This doesn't provide confidence that, even getting off of meds, pregnancy would be an easy thing. But that's a whole other issue, and while infertility can be an important issue for those with chronic illnesses, like RA, it's not something I'm going to address in more detail here, other than how it relates to medication and pregnancy.
The main types of medications used for the treatment of RA are Nonsteroidal anti-inflammatory drugs (NSAIDs), Corticosteroids, Disease-modifying antirheumatic drugs (DMARDs), and biologics (4). As NSAIDs and Corticosteroids can be taken during pregnancy, my focus here will be on DMARDs and biologics.