You’re pregnant, and you’re excited (congratulations, by the way!)… but you’re also worried. What does this mean for your rheumatoid arthritis (RA)?
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Good news: Healthy, successful pregnancies can absolutely be a possibility for people with RA.
“It’s about getting good counseling before conception and working with your doctor to accurately manage and control your RA,” says rheumatologist Emily Littlejohn, DO, MPH. “Good disease control with pregnancy-safe medications truly promises the best prognosis and healthiest birth for you and your baby.”
She delves into what you need to know about pregnancy and rheumatoid arthritis, including how best to manage your condition before, during and after pregnancy.
Getting pregnant if you have rheumatoid arthritis
For a long time, doctors believed that most people with rheumatoid arthritis would have an inactive condition during pregnancy with a tendency to flare up after birth (postpartum). But that is no longer necessarily the case.
“It used to be thought that most people would have a silent illness during pregnancy with a high chance of a relapse after birth,” says Dr. Littlejohn, “but now we have more data showing that if you come out of pregnancy with well…controlled RA, you’re likely to come out of pregnancy with well controlled RA.”
dr Littlejohn explains how, with the help of your healthcare professional, you can manage your RA and plan for a healthy pregnancy.
The goal is disease control
The term “disease control” refers to treating your rheumatoid arthritis, usually with medication. If your RA is well controlled, you should not experience daily pain or other complications typically associated with RA.
“Disease control means less pain. If you’re really well controlled with a regimen, you’ll have minimal pain, swelling, and stiffness,” says Dr. Littlejohn. “However, if your RA is uncontrolled, you will likely experience more of these symptoms.”
This can be especially the case during pregnancy, which puts new strain on your joints and changes the way the body deals with inflammation — which is why it’s so important to try to get your RA under control before you get pregnant.
Talk to your doctor about your plans
As with so many other aspects of your health, open and honest communication with your doctor is key. And if you have rheumatoid arthritis, it’s important to start communicating early. Even if you don’t want to spend years trying to conceive, it’s worth speaking to your rheumatologist now.
“When a patient of childbearing potential is diagnosed with rheumatoid arthritis, I am happy to speak to her immediately about her pregnancy plans to see if she would like to have a family,” says Dr. Littlejohn. “If they then want to have children, I would like to discuss the time frame.”
Knowing your time frame for starting a family can help your doctor determine your course of treatment, including what medications to prescribe and how they may need to change your treatment later.
Sort out your medication
The right medication is critical to controlling your RA. And if you’re planning to start a family, it’s especially important that you take a drug that’s known to be safe for pregnancy.
The key to getting your RA under control is often tumor necrosis factor (TNF) inhibitors, drugs that help stop inflammation — and most importantly, they’re now considered safe during pregnancy and breastfeeding. This contains:
- Adalimumab (Humira®).
- Certolizumab (Cimzia®).
- Etanercept (Enbrel®).
- Golimumab (Simponi®).
- Infliximab (Remicade®).
“These drugs have changed the game for people with rheumatoid arthritis who are trying to conceive,” says Dr. Littlejohn. “You can safely use them throughout your pregnancy.”
If you are taking an RA drug that is not safe for pregnancy, your rheumatologist will want to switch you to something else – and that may take a little while.
“We like to give people at least three months, but sometimes six months or more, just to make sure their RA is very well controlled before they get pregnant,” explains Dr. Littlejohn.
Do TNF Inhibitors Affect the Baby?
“TNF inhibitors pose minimal risk to the fetus,” confirms Dr. Littlejohn. “The only caveat is that there may be some changes to the vaccination schedule when your baby is born.” Doctors recommend that newborns who have been exposed to TNF inhibitors in utero should not receive live vaccines until they are at least 6 months old.
Live attenuated vaccines (commonly just called live vaccines) contain a weakened form of the virus they protect against. These include those to protect your child from:
- Measles, mumps and rubella (a combined vaccine known as MMR).
- yellow fever.
Try coming off steroids
Before you become pregnant, your doctor will want to make sure you’re taking the lowest dose of corticosteroids possible — or not taking them at all. These anti-inflammatory drugs can help relieve the symptoms of RA flare-ups.
“If your RA is really uncontrolled, you probably need high doses of steroids, which we use when patients flare up,” explains Dr. Littlejohn, “but becoming pregnant while taking these medications may pose a risk to both mother and baby.”
Prednisone is one of the most commonly prescribed corticosteroids for RA. Up to 20 milligrams of prednisone is considered safe for pregnancy, but more than that can cross the placenta and affect your baby. This can cause:
- Increased risk of premature birth.
- Low birth weight.
- Small for Gestational Age (SGA), a term used to describe babies who weigh less than the 10th percentile according to developmental expectations for babies at their gestational age.
- Premature rupture of membranes or amniotic fluid leaking out before labor has started.
Your RA symptoms may improve during pregnancy
It may come as a surprise to learn that rheumatoid arthritis can get better, not worse, during pregnancy. This is a common feedback from people who have RA and are pregnant. But why should this be the case?
“During pregnancy, the body goes into a dormant state where the disease becomes dormant or dormant,” explains Dr. Littlejohn. “We think the body does this to maintain and promote pregnancy.”
But again, if your RA is well controlled when you enter pregnancy, you should already be feeling pretty good – which means your RA is already pretty calm.
After the birth, see your rheumatologist
Are we sounding like a broken record yet? If you have well-controlled RA, it will likely remain well-controlled after birth. But it wasn’t always meant that way.
“We used to be very concerned about flare-ups after birth because that’s when the body’s immune system kicks in,” says Dr. Littlejohn. “However, we now know that patients who go into pregnancy in a well-controlled manner are likely to come out of it in a well-controlled manner.”
Still, it’s important to keep up with your RA treatment once your baby arrives to prevent or treat any flare-ups. She recommends seeing your rheumatologist within 90 days of delivery so they can assess your RA status and decide if you need changes in treatment.
Can pregnancy cause rheumatoid arthritis?
Statistics show that approximately 50% of patients develop RA during their reproductive years. But that doesn’t mean pregnancy is a risk factor for developing RA.
“The condition of pregnancy itself does not put you at risk of developing rheumatoid arthritis,” assures Dr. Littlejohn.
If you don’t have RA but experience significant joint pain during pregnancy, it can likely be attributed to the many physical changes that come with pregnancy.
“There can be a lot of normal pain that comes with pregnancy,” says Dr. Littlejohn. “When you’re pregnant, your ligaments relax more than normal, which is called ligament laxity. This can affect your joints and cause joint, hip or lower back pain.”
The opposite is also true: even if you have well-controlled RA, you can still experience some of the pain associated with pregnancy. While this is certainly not convenient or desirable, it also doesn’t necessarily mean you have an RA-related boost.
Is Rheumatoid Arthritis Genetic?
If you or your partner have RA, it’s possible your child will also get it — but that’s not a given. Many parents with autoimmune diseases give birth to healthy babies who don’t develop RA or other autoimmune diseases.
“Rheumatoid arthritis can run in families, and there is a genetic predisposition to the disease,” says Dr. Littlejohn. “But it’s not a direct heir.”
Your doctors will work together
Once you’re pregnant, it’s important to tell your rheumatologist that you’re pregnant and tell your gynecologist that you have RA. That way they can work together to ensure you get appropriate treatment for both of you.
“They will work together to target low levels of disease activity before and during pregnancy,” says Dr. Littlejohn.