Ankylosing Spondylitis and Pregnancy: What to Expect

Medically Reviewed by Tyler Wheeler, MD on August 02, 2022
5 min read

If you’re pregnant or considering it, it’s common to have a lot of questions and concerns on your mind. Do you need to breastfeed or bottle feed? Are labor and delivery hard? What should your diet look like?

But if you have ankylosing spondylitis (AS), your concerns might look a bit different. Can you get pregnant? Will AS make it hard to deliver? What if you have a flare-up during your pregnancy? Can you pass on AS to your baby?

Here’s a look at what you can expect if you’re planning for a baby, pregnant, or post-birth with AS.

Research shows that AS won’t affect your fertility. You can get pregnant. But you might need to plan ahead more than those without AS. This might be especially important if you need to stop taking some AS medications a few weeks or months before you get pregnant to prevent possible birth defects.

One effective way to plan your pregnancy is to take birth control. You can use any type of birth control. But usually, birth control like intrauterine devices (IUD) work best in the long run. IUDs are tiny, T-shaped devices your doctor inserts in your uterus to prevent pregnancy.

When you’re ready to try for a baby, let your doctor know. They’ll adjust your medications if you need them and remove the IUD. They’ll go over ways to manage your AS symptoms along with pregnancy.

Studies show some AS medications like cyclophosphamide and sulfasalazine may affect sperm production in men. This could make it harder to conceive. To avoid this, let your doctor know if you’re planning to get pregnant as early as possible. They may switch or stop certain medications accordingly.

Studies show that if you have AS, it’s not likely to cause complications during pregnancy. Most people with AS go on to have normal deliveries. As with any pregnancy, miscarriage (the sudden loss of a baby) is possible. Having AS doesn’t increase your odds.

But you’re more likely to have complications if you have severe AS symptoms or other medical conditions. You might also have complications if you develop high blood pressure (preeclampsia). It’s a condition that threatens the lives of both mom and baby during your pregnancy.

In such cases, AS-related complications could include:

  • Higher odds for early delivery before 37 weeks
  • Low birth weights in babies
  • Higher odds for cesarean section (C-section) during delivery
  • Neonatal intensive care unit (NICU) for your baby post-delivery

During pregnancy, as the baby grows, your body weight will increase over the course of 9 months. This can add a lot of stress to your body, especially your joints, muscles, and back. Your AS symptoms like stiffness, swelling, and pain might get worse as you step into the second and third trimesters.

You may get flare-ups anytime during the pregnancy. One study found that up to 80% of people with AS had flare-ups during pregnancy. And in almost all cases, the symptoms got worse a few months after delivery. In most cases, these symptoms get better in the long run.

Some pregnant people may not have any change in AS symptoms. In fact, in a small number of people with AS, the symptoms might reduce during pregnancy.

Once you’re pregnant, you’ll have to keep a few things in mind as your baby grows and you get closer to the due date.

Fetal development. Your doctor may have you continue taking some of the AS medications to help manage your symptoms as long as it doesn’t affect your baby’s health and development.

This includes over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, celecoxib (Celebrex), ibuprofen, and naproxen. It’s usually safe to take them up to 20 weeks of pregnancy. But beyond that, it may cause your baby to have kidney and heart problems. Check with your doctor about what’s right for you.

Passing on AS. Autoimmune conditions like AS are genetic and could run in families. If you have the HLA-B27 gene, there’s a 50% chance that you might pass it on to your children. But not everyone who has the gene develops AS. Studies show that up to 20% of children with the HLA-B27 gene will go on to have AS.

AS and delivery. Most people with AS have normal and healthy deliveries. But the pregnancy adds strain on your back, hips, and fused spine. This could make vaginal delivery difficult. The inflammation in your spine can also make it hard to get an epidural. It’s a procedure carried out by an anesthesiologist, a doctor who specializes in pain relief. During labor, they insert a long needle into the space around your spinal cord to numb the bottom half of your body to help you manage pain during contractions and pushing during vaginal delivery.

To prepare for this, speak to your OB/GYN and anesthesiologist ahead of time. Check if they have experience working with people with AS. They can walk you through your options. They may schedule a C-section to lower the risks to your baby and your spine health if you need it.

With AS, you’re more likely to give birth before 37 weeks. Talk to your doctor about what that might look like and how to best prepare for it.

Taking care of a newborn can be exhausting. But if you have AS, here are a few things you’ll need to watch out for.

Breastfeeding. AS doesn’t affect your ability to breastfeed or take most AS medications. But it’s possible to pass on some of it to your baby during feeds. If you’re planning to breastfeed, talk to your doctor ahead of time. They can help rule out medications that might not be safe for your baby.

Postpartum and AS symptoms. Your AS symptoms are likely to get worse or you may have a flare-up after you give birth. This may last a few months. If this happens, talk to your rheumatologist. They may adjust your dosage if you need it.

Taking care of a newborn. Newborns often need around-the-clock care. If you have AS, the added stress and pain in your joints and spine, lack of sleep, and fatigue might make your symptoms worse. It might be hard for you to carry out repetitive actions like picking up your baby, hunching over as you breastfeed, changing diapers, and sitting or standing up many times. You may need extra helping hands to meet the day-to-day needs of a newborn.

It’s also important to take care of yourself and pay close attention to your AS symptoms. Eat healthy, nutritious meals and try to catch up on sleep when the baby naps. Try to arrange for help before your due date. Ask family, friends, and loved ones to pitch in. If you’re able to, hire paid professional help.