Rheumatoid arthritis (RA) can be a challenging addition to your life, but the rest of your life still goes on. This means going to work, falling in love, having a family. And that’s where RA muscles its way into the picture yet again, bringing with it important questions. Will RA affect your ability to have a family? Is it safe to be pregnant while having RA or taking RA medication? What are the risks of passing on RA to your baby? How will are affect your ability to care for your baby? This post will try to answer all those questions and more!
(Source: The Arthritis Foundation)
RA occurs much more frequently in women than men. In fact, up to three times as many women as men have RA. As well, the rate of RA in women has increased in the past decade. Researchers theorize that environmental factors contributing to this increase may include smoking, vitamin D deficiency and lower dose synthetic estrogen in oral contraceptives. As the disease tends to develop primarily during the childbearing years, more women are facing decisions related to pregnancy and parenting.
In the past, women living with autoimmune diseases were often advised not to have children, but this is no longer the case. With some added supervision from your rheumatologist and your obstetrician, successful pregnancies are possible with RA.
(Source: The Arthritis Foundation)
Things to Consider Before Conceiving
Before you decide to get pregnant, it’s important to consider how pregnancy and your RA may interact so you can develop a plan to manage any potential problems or complications. The American College of Rheumatology recommends that your disease be well controlled for about six months before you try to conceive. RA may impact your ability to conceive, especially more severe RA, so the more stable your disease is before you start trying to have a baby, the better for your joints.
You should also consider the severity of your RA. Do you have systemic complications, such as heart or kidney problems? Such extra-articular (outside the joints) manifestations can affect your health during pregnancy. These and other factors can make your pregnancy high risk. Make sure you have an in-depth conversation with your obstetrician and your rheumatologist so your medical team is aware of your decision to start a family. Sharing information means they will be able to provide the care you need during pregnancy.
RA itself does not appear to affect pregnancy or your baby’s health. Most women with RA have normal pregnancies, although a small number may have a slightly higher risk for miscarriage or low-birthweight babies. On the other hand, pregnancy can affect RA. The bad news is that having a baby may increase ACPA-negative RA, that is, a minority of people whose RA does not test positive on the anti-CCP bloodtest.
The good news is that in pregnant women with RA, 70 to 80 percent experience a decrease in symptoms, with many actually going into remission! One possible explanation for this is that pregnancy may dampen the immune system to prevent it from mistakenly seeing the fetus as a foreign body and attempt to attack it. As RA is an autoimmune disease, a lowered immune system makes you feel better. Unfortunately, this effect tends to be temporary. Most women experience a recurrence of symptoms within 6 to 8 weeks of giving birth.
One last factor to consider is the risk of passing on RA to your baby. The disease develops when certain environmental factors trigger the development of RA in people who are genetically predisposed to it. Not everyone who are genetically predisposed to RA will develop the disease. The risk of passing on RA to your child is very low – first-degree relatives (that is, sibling or child) have less than a five percent risk of developing RA. That means your baby has a 95 or more percent chance of not getting RA. Those are really great odds. Still, some families seem to have a type of RA that is very genetically linked, with a grandmother and mother and her daughter all having RA or another type of inflammatory arthritis. If this is your family, your baby may have a higher risk. You may want to consult a genetic counselor to take a closer look at the risk and then discuss your results with your partner and doctors.
RA Medications and Pregnancy
Once you’re pregnant, it’s important to protect the fetus from substances that can affect its development. This is why pregnant women avoid for instance, salami, raw eggs, and cleaning the cat’s litter box. Medication is also on the list of things to avoid, but with an added caution. Some medications should be avoided during conception and others during the pregnancy itself.
Many of the RA meds may not be dangerous to the fetus in the earliest stages if your pregnancy was a happy accident, rather than planned. Several of the Biologics, such as the TNF blockers, do not appear to cause any damage to the early fetus, so if you happen to get pregnant while on a biologic, you and your baby will most likely be okay. Most doctors might recommend that you get off your RA meds before trying to conceive, but again, this depends on the state of your RA and your general health. Be sure to have a conversation with your rheumatologist and your obstetrician to get more details about your individual case.
There are two medications used for RA that are dangerous to a developing fetus: methotrexate and Arava (leflunomide). Both of these medications can cause severe birth defects and it’s important to not get pregnant while taking these drugs. Doctors usually recommend that you be off methotrexate for at least three months before trying to conceive. Arava, on the other hand, stays in your body for a very long time, up to two years. If you are on Arava and you want to become pregnant, it’s recommended that you complete a washout regimen to make sure the medication is completely out of your body. Not much research has been done on indirect exposure to medication, that is, if the father is on an RA medication. However, Arava is so toxic to a fetus that it is also recommended that men complete the washout regimen prior to the couple conceiving. (1)
(Source: American College of Rheumatology)
Although women ideally should not take any medication during pregnancy, the reality is that sometimes what is best for you and your baby is to control your RA. It is estimated that 40 to 50 percent of pregnant women with RA will need some sort of drug treatment during pregnancy. Some medications may be safe. These tend to be the older medications that have been on the market a long time and have been researched more, including antimalarials and prednisone. The Biologics have not been on the market long enough to get a full understanding of how they may affect the developing fetus.
You, Your Baby and RA
Once your baby is born, it’s important to focus on getting to know and falling in love with this new human being you’ve created. It’s also important to continue to consider RA as you grow into parenthood.
Breastfeeding your baby can have good effects on both the child’s health and yours. Breastmilk helps build immunities in your baby, while offering added protection against breast cancer for you. Some studies indicate that breastfeeding may cause a flare of RA symptoms, however, another study showed that women with RA who had never breast-fed had higher severity and mortality related to RA. You have to balance the decision to breast-feed with what is right for you and your baby.
If your RA is active, it may be more important for you to get your disease under control. Experiencing the deep fatigue and high pain levels of an RA flare can make it difficult to take care of your baby. In this case, getting back on RA meds may be the best decision for the two of you. Some RA drugs are safer for breast-feeding, while other should be avoided. Again, make sure you talk to your doctor as you make decisions in this area.
Taking care of a small child can be challenging when you have RA. There’s usually a lot of lifting and activity near the floor. If this is hard for you, there are tools available to make the physical aspect of caring for a baby and toddler easier. Often, knowing what parents with disabilities do can be useful. The Parents with Disabilities Online website includes a section on adaptive parenting aids that can also be useful for people with RA.
Getting in touch with others in the same situation can help you identify potential concerns, develop plans and get the emotional support that is essential to new mothers. Suzie Edward May is the author of Arthritis, Pregnancy and the Path to Parenthood, an excellent guide to pregnancy and RA, as well as being a new mother. Moms with RA is a community website for mothers who live with inflammatory and autoimmune conditions. Having a community of others like you can make your journey into motherhood a much more successful one.
Some women worry about the impact RA may have on their ability to be a “good mother.” Relax. You will find a way to be the best mother you can be, even when it means adapting how you are a mother to accommodate your RA. There is no “normal” in parenting — everyone does it slightly differently in a way that works for them. Your child will love you just the way you are. You will be mommy and no one can do that job as well as you!
(1) Brent, Robert L., Teratogen Update: Reproductive Risks of Leflunomide (Arava™); A Pyrimidine Synthesis Inhibitor: Counseling Women Taking Leflunomide Before or During Pregnancy and Men Taking Leflunomide Who Are Contemplating Fathering a Child. Teratology. 2001 63:106–112
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Lene writes the award-winning blog The Seated View. She’s the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.
Published On: May 07, 2014