Rheumatoid arthritis (RA) is a systemic inflammatory disease. Still, it mainly affects the joints. But as the disease progresses, it may affect other parts /organs of the body that have nothing to do with the joints. The good news women with the disease can still have normal pregnancy. If you’re getting pregnant with RA, here are pieces of information you need to know!
The complications of RA can be dangerous and even life-threatening. Interestingly it is more likely to be inactive during pregnancy. Even if it is active, it should not harm the developing baby as long as it’s controlled as well.
RA is an autoimmune disease, a condition of when the immune system goes awry and mistakenly recognizes its own healthy tissues as ‘harmful or foreign invaders’.
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No one knows exactly why the disease is more likely to go into hiding in pregnancy, but there are some theories. The main one is pregnancy may make the body immune system less active, and as a result there will be less inflammation and pain.
It’s also thought that RA doesn’t directly affect both male and female fertilities – though the conception in women with RA can take longer than women without the disease (inconsistent ovulation and decreased sexual drive are some possible explanations). In men, the sperm count may be affected when the disease flares up – but this is usually temporary! In general, fertility in both genders is probably normal in well-treated RA.
But if the disease flares up and it’s poorly controlled during pregnancy, this can carry some serious complications such as birth defects, low-birth weight babies, or miscarriage.
Furthermore, not all RA medications are safe for pregnancy. Leflunomide (Arava) and methotrexate (Rheumatrex), for examples, can increase the risk of birth defects. They may also cause birth defects if taken by men with RA who father children!
So for both women and men with the disease, they should talk with their doctors about the treatment plan before they try to conceive. Some adjustments may be required, especially to make sure that the medications are safe for their developing baby.
The effects of some medications may still linger in the body for a period of time after you discontinue taking them. Therefore, your doctor can consider switching to another medication (less risky medication) for at least a few weeks, months, or even years before you and your partner try to get pregnant!
For more comprehensive guide, see your doctor /rheumatologist as soon as you’re considering beginning a family! The effects of some medications may need a months-long ‘washout’ period to clear up.
Leflunomide, for example, has long half-life – you may need to stop it 2 years before trying to conceive, though there are also ways to remove it out of your body more quickly. Meanwhile, use your contraception until you’re ready to become pregnant!
It’s also important to understand about your prenatal vitamins and supplements. With or without RA, your pregnancy requires plenty of essential nutrients! And if you want to take any over-the-counter herbs, talk to your doctor first!
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Getting pregnant with RA could be more challenging, but this doesn’t stop you from having normal pregnancy. Even if the disease flares up during pregnancy, some treatments are available. With right prenatal care and treatment, babies born to mothers with RA can be as healthy and happy as any!
The good news, the future looks great for RA treatment. New type of biologic treatment promises a better outcome of the disease. With early and aggressive treatment, the complications of the disease should be preventable. Some experts believe that new treatments will keep the disease off for years or even decades.
While it seems that the symptoms of the disease are more likely to improve in pregnancy, they can also persist or worsen in a few cases.
In other words, not all pregnant women with the disease are free from their RA symptoms. Even about 40-50 percent of women with RA need to take medications to control the disease and ease the symptoms, particularly in the first trimester.
Fatigue is common symptom of pregnancy. If you already have a problem with tiredness associated with your RA, this may worsen – at least until your second trimester. About 70 percent of pregnant women with the disease find that their RA symptoms begin to improve in the second trimester.
But fatigue can also have nothing to do with the disease as the pregnancy progresses and the baby grows. For example, fatigue in third trimester may get worse since your baby is bigger in size and you’re closer to your delivery.
Rheumatoid arthritis treatment in pregnancy
If you’re pregnant and the symptoms of the disease don’t improve when you’re expecting, or even if you have flares – talk with your doctor! Some RA treatments during pregnancy are available. For example, your doctor may prescribe Plaquenil (hydroxychloroquine) to help ease the inflammation.
Again, not all medications for RA are safe during pregnancy. The following are a few special precautions you need to know: