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Arthritis in Pregnancy

Deciding to become pregnant should be a conscious decision for all women.  If you have arthritis and are pregnant or are thinking about having children you may want to ask yourself these questions if you haven't already:

  • Am I ready?
  • Will my arthritis go away?
  • Will my child inherit arthritis?
  • How will arthritis affect my pregnancy?
  • How will pregnancy affect my arthritis?
  • How can I plan ahead for my pregnancy?
  • How can I make it easier to care for myself and my baby after birth?

Pregnancy alters your immune state which could possibly contribute to a change in the course of your arthritis.

Because arthritic conditions are so variable it is important to get advice from your doctor or specialist nurse before you try for a baby. In particular, some of the drugs you are likely to be taking for your arthritis may need to be stopped before conception.

It is therefore better to try for a baby while you are in a good phase with your arthritis so you can reduce the drugs you need to take without leaving you in unbearable pain.

You shouldnot stop taking prescribed drugs without talking to your doctor first. Your doctor will prescribe the safest combination of drugs at the lowest reasonable dose to reduce the risk of them causing problems with your pregnancy and still help to keep your arthritis under control.

Stopping your drugs could make your arthritis worse, but your doctor will be able to advise you on drugs that you’ll be able to take. You may also be able to use other pain relief treatments, such as physiotherapy or acupuncture.

Conception and fertility problems

Your fertility isn’t likely to be affected by arthritis, but it may take longer for you to become pregnant. An increased rate of miscarriage is seen in some patients with lupus and antiphospholipid syndrome (APS). In other patients, the condition being active and taking certain drugs (such as cyclophosphamide) are the main risk factors that make it more difficult to get pregnant. This means it’s very important to plan to get pregnant at times when your condition is under control and stop certain harmful drugs in advance.

Most women get aches and pains, particularly backache, during pregnancy.  The effect of pregnancy on arthritis varies depending on the type:

  • Most women with rheumatoid arthritis will be free of flare-ups during pregnancy, although they will probably return after the baby is born.
  • If you have osteoarthritis, particularly of the knee or hip, the increase in your weight as the baby grows may cause you problems.
  • Other disorders, such as ankylosing spondylitis, may improve or become worse – there’s no consistent pattern.

The physical changes that normally occur during pregnancy may affect joints and muscles in the following ways.

  • Joints may become looser and less stable.
  • Knee problems may become worse due to increased weight or because the muscles along the side of the knee become weaker.
  • As the uterus grows your spine curves slightly to support it. This can lead to muscle spasms in the back. Sometimes this can also cause pain numbness and tingling in the legs.
  • Water weight gain may increase stiffness especially in weight-bearing joints (hips knees ankles and feet). It may also cause problems with carpal tunnel syndrome--a condition that causes pain numbness and tingling in the thumb index and middle finger. This usually goes away after delivery.

Your arthritis shouldnot usually affect the delivery of your baby. However, if you have arthritis in your back or hips then moving these joints during labour may cause pain. Different positions can be used in childbirth which should allow you to give birth naturally, even if you’ve had hip replacements.

If you have a lot of back problems, it is a good idea to talk to an anaesthetist about whether you should have an epidural for pain relief.

Coping with the demands of a small baby is exhausting for any new mother, and if you have arthritis the stresses can be much greater. Women with rheumatoid arthritis may find that their arthritis flares up again in the weeks after the birth (often after going into remission during the pregnancy). Before the birth it may be worthwhile to arrange for extra help from family and friends once the baby is born.

If your drugs for arthritis were stopped before or during the pregnancy most doctors recommend going straight back on them, except where the drugs would stop you breastfeeding. Because of the benefits of breastfeeding, some women prefer to wait until the arthritis flares up again before returning to their medication. Ask your doctor or rheumatology nurse specialist for advice on this.

 

 

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