How Rheumatoid Disease affects pregnancy planning
Pregnancy planning is a common challenge for people diagnosed with Rheumatoid Arthritis. Concerns include infertility, disease activity, pain control, and possible disability, which can interfere with caring for a child. Valuable resources include clinical studies and other publications, and the practical stories of other patients. While there is no clear roadmap, patients need to be informed about various issues and options.
Infertility and Rheumatoid
It’s not our imagination that women with Rheumatoid Disease have fewer children. Recent research confirms that “more than one-half of young women with RA or SLE (Lupus) had fewer biologic children than desired,” Arthritis Care & Research. Rheumatoid patients were more likely to experience infertility, while Lupus patients had greater miscarriage risk.
The risk of infertility can impact whether or not to delay pregnancy. It is unknown yet the reasons for infertility related to Rheumatoid disease and whether disease treatment impacts the likelihood of successful pregnancy. More study is needed. The Rheumatoid Patient Foundation (RPF) is collaborating with a researcher to study pregnancy and RA, so if you plan to get pregnant and want to be notified when the study starts, please let me know on the comments’ page or in an email.
Which Rheumatoid Arthritis medications are safe to continue?
Recently posted on the blog: “I’m 30 years old and trying to conceive our first child. I have RA and currently on Actemra and I was wondering if anybody has had a child while in this med or currently pregnant? Should I continue or stop and what should I expect? Super scared and need some help please”
It’s clear which medications are considered unsafe to continue, such as methotrexate and leflunomide. It’s less clear which ones are actually safe, so many doctors recommend discontinuation of all DMARDs. However, data presented by Organization of Teratology Information Specialists (OTIS) provides some reassurance that other DMARDs, including Biologics, might eventually be considered safe during pregnancy. Clearly, much more study is needed here too. The OTIS registry studies those who have become pregnant while taking medications, and provides related resources. You can contact OTIS at this link.
How soon do I give up Rheumatoid Arthritis medications for pregnancy?
A question posted recently on Facebook shows concerns that are common for patients considering pregnancy: “How does anyone give up meds for 6 months before trying to get pregnant. I would love another baby but couldn’t give up meds 6 months before trying to conceive and then after having the baby getting meds in before the pain starts. Any advice?”
Rheumatoid patients who intend to become pregnant should discuss all medications with both an obstetrician and a Rheumatoid Arthritis specialist. Usually, they will be counseled to stop using medications that are known to be unsafe three months prior to becoming pregnant. Leflunomide can remain in the body longer than other DMARDs, and there is a washout procedure to remove it, but a rheumatologist I know called it “unpleasant.” If planning a pregnancy, it would probably be best to not begin medicines that are considered unsafe, but that does not mean a woman will necessarily have to endure nine months of unrelieved pain.
Successful pregnancies with RA?
Many women have had successful pregnancies with Rheumatoid Disease, as they have discussed in comments on RAW, and in social media, and on their own blogs. Frequently, women experience an improvement of disease symptoms during pregnancy. But that is not universal, and there is no guarantee. Pregnancy with disabling Rheumatoid symptoms can be difficult, but some symptom relieving medications may be prescribed to provide relief, including low dose prednisone, acetaminophen, and ibuprofen during the first and second trimester. Since many pregnant women prefer not to take any medication during pregnancy, planning should be considered for alternative methods for pain relief in case it is needed. I love how one blog ends after the completion of a successful pregnancy with Rheumatoid Arthritis. You might also enjoy reading the story of a successful pregnancy with Psoriatic Arthritis.
Men, pregnancy planning, and Rheumatoid Disease
Certain issues are equally relevant for men with Rheumatoid disease. Medications that can affect the baby’s health would need to be curtailed, just as for women. Physical disability and financial difficulty caused by the disease are similarly significant as they are for women.
Important note: RPF is working with a researcher to study pregnancy and Rheumatoid Disease, so if you plan to get pregnant and want to be notified when the study starts please let me know in a comment using a first name only or email me.
Rheumatoid Arthritis and Pregnancy – This page has links to several resources, and dozens of helpful comments from other patients.
- The “Can’t” Question with Rheumatoid Arthritis
- Living with Rheumatoid Arthritis: Tips for Parents
- 20 Questions RA Patients Should Ask a Doctor