Here's some good news: If you have RA, you may not be plagued by joint pain and inflammation during your pregnancy. For many women, RA tends to go into remission during pregnancy. What’s more, RA does not seem to affect your chances of getting or staying pregnant, the way other autoimmune diseases such as lupus may.
Researchers are not 100% sure what it is about pregnancy that makes RA go into hiding, but several theories are bandied about. One is that pregnancy dampens your immune system. Changes in your immune system during pregnancy prevent your body from seeing the baby as a "foreign" invader. This means that your immune system doesn't work as actively as it did before. RA and other autoimmune disease are caused when the body’s immune system goes haywire and attacks its own healthy tissues and organs.
This is not to say that pregnancy will be a honeymoon from joint pain for every woman with RA. Some woman don’t improve while they're expecting, and some may suffer flares.
“Some form of drug treatment may be necessary in 40% to 50% of pregnant women with RA, but they usually get by with low-dose steroids or the antimalarial Plaquenil [hydroxychloroquine], both of which are considered safe during pregnancy and while breastfeeding,” says Elaine Husni, MD, vice chairwoman of rheumatology and director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic in Ohio.
Although RA may go into remission, don't be surprised if you have some aches and pains during pregnancy. That doesn't necessarily mean you're having a flare, says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn. “Don’t panic and think it’s a flare -- it could just be a part of pregnancy,” she says.
"The flip side is that RA may flare in the months following delivery,” Husni says. "Again, this is not a given, many women do well in the postpartum period."
If you are thinking about breastfeeding, there are certain medications that can be used safely to help cool inflamed joints during a postpartum flare. But some of your rheumatologists’ bigger guns, such as methotrexate and biologics, cannot be used while breastfeeding.
If the pain and inflammation becomes overwhelming, “we can always initiate other medications back postpartum, but it takes a while for them to begin working,” Amin says.
Prenatal Care Counts
The best way to ensure a healthy pregnancy and baby is the same whether you have RA or not. For starters, eat a healthy diet, don't gain too much weight, exercise if your doctor says it's OK, don’t smoke or drink alcohol, and avoid fish with high levels of mercury. If you take fish oil to fight inflammation, check with your doctor to make sure you take supplements that are mercury free.“Good prenatal care is essential for all pregnant women,” says Amin.
