First, Do No Harm continued...
“I had to get off methotrexate and be off of it for three months before I could start trying,” Soos says. She also had knee surgery around this time. “As soon as I went off methotrexate, I started to flare and could not function,” she recalls. “I couldn’t get dressed or lift my arms. I dreaded getting out of bed in the morning.”
Unfortunately, this can be a fairly common scenario, explains Amin. And it’s definitely one that gets a woman out of the mood to try and get pregnant. “Who wants to try and conceive while in so much pain?” Soos asks.
She took prednisone for a while, and was recently switched to another medication that's safe to take while trying to conceive. “I have been feeling wonderful ever since,” she says.
For some women, waiting until their RA is under control before trying to get pregnant may be a smart choice, says Emilio B. Gonzalez, MD, chief of rheumatology at University of Texas Medical Branch in Galveston, Texas. “I sit down and tell them that many treatments for RA are not compatible with pregnancy and if they are really suffering, perhaps the priority is to get the RA under control and then start planning their family at a later date,” he says. “If you have RA, it doesn’t mean you should not get pregnant, but it can be a challenge to manage the RA before and after pregnancy.”
If your RA is under good control before pregnancy, there is a good chance it will stay that way.
Managing RA Flares During Pregnancy
For women who choose to stay off any medication during their pregnancy, “We monitor the pregnancy to see if they have flares, [and] we can use medications that are safe to manage these flares,” Amin says.
While prednisone is safe during pregnancy, it may increase an expectant mom's risk of high blood sugar and high blood pressure, so you'll need to monitor levels closely. High blood pressure in pregnancy is a risk factor for preeclampsia, which can be a life-threatening condition. High blood sugar may mean gestational diabetes. Steroids also increase risk of bone loss.
None of this means that a women with RA is necessarily considered high-risk, she says. “The pregnancy can be followed by a regular obstetrician," Amin says. "However, if the obstetrician is uncomfortable with medications, a woman may wish to be followed by a high-risk obstetrician."
Many pregnant women with RA work closely with both their obstetrician and their rheumatologist to manage their pregnancy. “If the obstetrician isn’t sure if it’s a flare or not a flare, they can consult with the rheumatologist,” says Manju Monga, MD, the Berel Held Professor and the division director of maternal-fetal medicine at the University of Texas.