Pregnancy and Inflammatory Arthritis

When you suffer from inflammatory arthritis it is important to plan your pregnancy so you can be on a medication that is compatible with pregnancy when clinically needed. If a pregnancy is planned, your doctor can help to make you as well as possible before you conceive.

Thinking ahead

• Around half of pregnancies are unplanned
• The effectiveness of birth control depends on the method and its correct use. With some methods of birth control, there is up to 28% chance of an unplanned pregnancy within the first year of typical use

So even when you are not considering having a baby this information might still be important for you.

Top Tip – discuss your family planning options with your healthcare team (e.g. your GP, nurse, rheumatologist, obstetrician and gynaecologist, midwife and pharmacist) early on.

Having inflammatory arthritis doesn't mean you can’t get pregnant, but it may take longer than usual to conceive. This can be due to many different reasons, including disease activity or medications you may be taking.

Controlling your symptoms before pregnancy is essential to help ensure you and the baby have the best health possible. This can also help to reduce the chance of pre-eclampsia, an early delivery, the baby having a lower birth weight or of having a miscarriage.

There may be a need to continue to control your disease before, during and after pregnancy. However, not all drugs are compatible with pregnancy, so your rheumatologist will be able to explain if your treatment needs to be adapted. On the other hand, there are treatments available that are compatible with your pregnancy. Speak to your healthcare team about the most suitable options for you.

Deciding when to get pregnant can be difficult. It may help to wait until your symptoms are controlled. Following a healthy lifestyle beforehand could also help make your pregnancy easier. However, delaying pregnancy may make it more difficult to conceive as older women may take longer to become pregnant.

Once you decide to become pregnant, you should continue or start taking vitamin and mineral supplements suggested by your healthcare team. Consult your healthcare team if you are taking medications including for treatment of your inflammatory arthritis. Your healthcare team should check for drug interactions and advice regarding its use.

There are three stages of pregnancy (the first, second and third trimesters [each of which is three months long] and 40 weeks in total).

Pregnancy triggers short term changes in your immune system. As a result, some women with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) experience their symptoms improving or disappearing during pregnancy especially in the second and third trimester. In some women symptoms do not change or may even worsen and therefore 1 in 2 women living with RA, PsA or axSpA still need treatment during pregnancy.

It is important to plan for the possibility of flares during pregnancy and after birth by enquiring about suitable medication, making lifestyle adjustments if necessary and discussing any support you might need with your partner and social network.

Several treatment options are available that are compatible with pregnancy and breastfeeding.

Not all vaccinations can be given during pregnancy or when taking certain treatments. Consult your healthcare team about the vaccinations you may need.

There is usually no reason why women living with inflammatory arthritis should not have a normal delivery. Sometimes if you have arthritis in your back or hips labour can be more difficult. In these situations, different labour positions can be used and epidural anaesthesia can be considered. Caesarean sections may also be considered. It is advisable to discuss all these options with your healthcare team during pregnancy to plan the optimum delivery for you.

Looking after a newborn baby can be very demanding, especially if you are living with inflammatory arthritis. You may feel tired managing both your symptoms and the demands of your newborn, and there is also the possibility that you will experience flares in your symptoms.

There is no consistent symptom pattern for women with inflammatory arthritis. Even if your symptoms get better during pregnancy, they may return after delivery. Having your disease under control can help you manage this challenging but special time.

Additionally, ask your partner, family, friends and support networks for help whilst you get used to life with your newborn. This will give you more time to rest if you need to.

Make sure you ask for guidance from your healthcare team and for extra support from social services, physiotherapists or occupational therapists who can give you advice to make holding, dressing, washing and feeding your baby easier. Your healthcare team may also be able to provide information about specifically designed products which could assist you in taking care of your baby.

Please talk to your healthcare team before the birth to discuss a delivery plan.

Many women with RA, PsA or axSpA are able to breastfeed successfully. Whether you decide to breastfeed or not depends on several factors, including your personal choice, your treatment and your level of disease control.

Breastfeeding is beneficial for both you and your baby, however not all drugs can be used when breastfeeding as some may pass into breast milk. Stopping treatment in order to breastfeed may worsen symptoms and impact your ability to care for your baby.

It is very important that you talk to your healthcare team before making any decisions about your treatment plan. They will ensure that your treatment is compatible with breastfeeding.

By discussing treatment options ahead of time, you can adapt your treatment if necessary and you would not have to choose between breastfeeding and treatment.

You may be worried about passing on your disease. The way your disease is inherited is complex. The risk of passing on the disease varies between up to 1 in 30 for RA and PsA, and between 1 in 6 to 1 in 10 for AS/axSpA.