What You Need to Know About RA and Pregnancyby Lene Andersen, MSW Patient Advocate
In the past, women with rheumatoid arthritis (RA) were advised against becoming pregnant because limited treatment options meant most people with the condition have active disease. This is no longer the case.
Advances in treatment and treatment approaches have made pregnancy with RA not just possible, but quite common. Still, RA can present extra challenges when you’re thinking of starting a family. Working proactively with your doctors can make your pregnancy a much better experience.
Is Your RA Under Control?
The American College of Rheumatology (ACR) recommends that your RA be well under control before trying to conceive. Studies have shown that women with RA may take longer to get pregnant as well as having a slightly higher risk of miscarriage. Also, carrying a baby to term can be pretty hard on your body. Being as healthy as possible can make the process of becoming and being pregnant easier for you.
How Severe Is Your RA?
RA is a systemic autoimmune disease. It affects joints and other systems in your body, such as organs and the vascular system. If you have had experience with systemic disease or your RA is active, it may increase your risk of pregnancy complications. As well, women with more active disease may have a higher risk of miscarriage. This is another reason it’s important that your RA be under control before you conceive.
What Medication Are You Taking?
The ACR recommends that you continue treating your RA during pregnancy, provided the medications you take are safe.
Two medications are not, having the potential to cause serious birth defects: methotrexate and leflunomide (Arava).
In fact, they can be so toxic to your baby that it’s recommended you stop them prior to pregnancy — three months before trying to conceive for methotrexate and two years for Arava. You can also complete a washout regimen to get the medication out of your system. It is strongly recommended to discuss the safety of the medication with your rheumatologist and your Maternal-Fetal specialist.
Connect Your Medical Team
People with chronic illness usually develop a diverse medical team that includes a number of different specialists. If you are thinking of starting a family, connect your obstetrician/gynecologist with your rheumatologist and start having a conversation with them about how to manage pregnancy with RA. Sharing information means they will be better able to provide the care you need during pregnancy.
Will RA Affect My Baby?
Overall, RA itself does not affect the health of the developing fetus and most women have normal pregnancies with the condition. However, there are some risks that need to be managed during the pregnancy. For instance, RA is associated with a slightly increased risk of premature birth and a low birth weight. As well, if you have had kidney disease, which is possible due to the systemic aspect of RA, it could cause potential complications.
Will I Pass My RA to My Baby?
We don’t yet know what causes RA, but we do know that it is a combination of environmental factors and genetic predisposition. The gene HLA-DR4 seems to play a small role in RA, but the interaction with environmental factors, especially smoking, are more important.
Although RA does seem to run in some families, overall, the risk of passing the condition on to your children is small — estimated to be about 1-3 percent. That means that there is a 97-99-percent chance they won’t get it.
Will Your RA Get Worse During Pregnancy?
Not only will your pregnancy give you a beautiful baby, but as an extra bonus, it’s likely to make your RA lessen temporarily! Up to 70 percent of women with RA experience a decrease in symptoms while pregnant; some even going into remission. In such cases, the condition tends to come back about six weeks after delivery. Continuing to take your RA medications may help prevent this recurrence.
What About Labor and Delivery?
As part of your birth plan, make sure to discuss labor and delivery positions with your doctor or midwife. You may have to get creative to reduce the strain on your joints and there are several options that may work better for you than the traditional lying down. Women with RA do tend to have a higher incidence of C-sections. This is due to disease activity in the hips, which may get in the way of spreading your legs as wide as is necessary to give birth.
How Will RA Affect Your Ability to Care for Your Baby?
Being a parent is physically intense, especially when your child is really little. RA comes hand-in-hand with fatigue and being kept up at night by a restless baby will add to this. As well, physically lifting and holding your baby may be a challenge to people with RA. Adaptive equipment used by parents with disabilities may help you. Having plenty of support from a partner, family, or friends can be an important factor in how much you enjoy these early stages.
Can I Breastfeed?
Breast-feeding provides a number of benefits to both mother and baby and if you experience remission in symptoms during the pregnancy, breast-feeding may extend that.
If you did not experience remission, many RA medications are now considered safe for breast-feeding, however, you need to discuss the safety of them for the baby with a Pediatrician or OB/GYN. Holding your baby during feeds may be a bit of a challenge, but support pillows can make this special time that much easier on your body. If you have problems with any part of the breast-feeding process, a lactation consultant can help.