If you have rheumatoid arthritis (RA) and are thinking about starting a family, you probably have lots of questions and concerns. Will your RA affect your chances of getting pregnant? Are your medications safe during pregnancy? What if you decide to stop taking them? Will your RA flare?
These are all questions that need to be discussed with your rheumatologist, preferably in advance of becoming pregnant, says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn.
RA, an autoimmune disease in which the body engages in friendly fire against its own joints, primarily strikes women of childbearing age. The good news is that unlike other autoimmune diseases, RA does not seem to affect a woman’s fertility or ability to have a healthy pregnancy. Your symptoms may even get better during pregnancy, but they may flare about three months after delivery (right around the time that the sleep deprivation from having a newborn kicks in).
“Unless you have other RA complications such as lung or hip involvement, the RA should not affect your ability to become pregnant, carry the baby to term, and deliver naturally,” Amin says. That said, a little medication counseling goes a long way toward achieving these goals, she says.
Take Stock of Your Medications
“Women with RA need to work with their obstetrician and rheumatologist to make sure they are on safe medications prior to conceiving, and if they are not, they need to change or discontinue their medications based on their disease activity and preferences,” she says.
Some RA medications that pregnant women should not take include methotrexate and Arava (leflunomide). Women must be off these drugs for a period of time before even becoming pregnant. Other medications such as prednisone, Plaquenil (hydroxychloroquine), sulfasalazine, and Imuran (azathioprine) are generally considered safe to take during pregnancy. The jury is out on some of the newer biologic agents such as Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab), Amin says.
What if you don’t feel comfortable taking medication while you are pregnant? “Some women do wish to discontinue their medication altogether, and I discuss the risk of a potential flare with them, but I also explain that there is a chance that their disease may improve while pregnant,” says Amin. Doctor's don't really know exactly why RA tends to go into remission during pregnancy, but it's a common thing.
That’s not to say you will feel great for your entire pregnancy. But if your back aches or your ankles swell, don’t assume the worst, Amin says. “These symptoms may just be part of a normal pregnancy.”
First, Do No Harm
Bonnie Soos, a 32-year-old schoolteacher in Adina, Ohio, was diagnosed with RA 11 years ago. She has spent the better half of the last two years trying to get pregnant.