Tips for Managing RA During Pregnancy With Twins

Pregnancy is physically hard on the body. It may be particularly taxing if you have rheumatoid arthritis (RA). RA is an autoimmune disease that occurs when the body mistakenly attacks its own joints, causing pain, inflammation, and ultimately, joint damage.

9-Month Reprieve?

The good news is that many women with RA notice an improvement in their symptoms during pregnancy. There's even a chance your RA could go into remission while you're pregnant.

If your RA symptoms ease during the first trimester there's a good chance your symptoms will stay mild through the rest of your pregnancy.

Even if your symptoms improve during pregnancy, it's likely your RA will flare again within the first three months after giving birth. Talk with your doctor ahead of time to plan for a possible flare after your twins are born.

Tips to Help Manage RA

Here are some tips on managing your RA during your pregnancy and in the weeks and months that follow:

  • Watch your weight gain. Even if your RA goes into remission during pregnancy, the added weight on your body puts extra pressure on your joints. Make an effort not to gain more weight than is recommended. This will make it easier to lose weight after you give birth. Ask your doctor what amount is right for you.
  • Ask about your medicine. Talk with your doctor about what RA drugs you can safely take during pregnancy. For example, prednisone and other steroids are generally safe, but methotrexate and leflunomide are not. Don't forget to ask about over-the-counter drugs, too. Some, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), are safe earlier in pregnancy. But you should avoid these drugs later in pregnancy. If you plan to breastfeed, check with your doctor about which drugs you can take during this time.
  • Get your vitamins. All pregnant women need extra vitamins and minerals -- and taking a good prenatal vitamin can help ensure you're getting enough. But when you have RA, you may need more calcium and vitamin D to help prevent the bone thinning some RA drugs may cause. Ask your doctor if you need to take extra calcium and vitamin D to protect your bones. If you're breastfeeding, you may need to continue to take these supplements after you give birth.
  • Exercise after giving birth. It can be hard to find the time and energy to exercise when you have twins at home, but exercising after pregnancy can help you lose weight and maintain that loss, which is good for your joints. Exercise can also help reduce joint stiffness and pain.


Once your doctor has told you it's safe to exercise, start by taking short walks several times a week and build up from there. If you're ready for more active exercise, choose those that go easy on your joints, such as swimming or bicycling.

  • Eat a heart-healthy diet. Having RA puts you at higher risk of heart disease. This makes it especially important to make heart-healthy food choices during your pregnancy. Experts recommend a low-fat diet that is high in carbohydrates and fiber. This means a diet with plenty of vegetables, fruits, and whole grains. When you do eat fats, opt for healthier choices, such as the monounsaturated fats found in olive oil and canola oil; fish; and nuts like walnuts and almonds. Limit the less healthy fats found in meats and fried and processed foods. Ask your doctor or dietitian to help you come up with a pregnancy diet that works for you.
  • Avoid foods that cause flares. Although there's no specific link between RA and diet, some women find that certain foods make them feel worse. If there are any foods that tend to trigger a flare for you, avoid them after you give birth, when you're more likely to have a flare.

WebMD Medical Reference Reviewed by Nivin Todd, MD on January 16, 2019



Arthritis Today: "Exercise with Rheumatoid Arthritis," "Rheumatoid Arthritis and Pregnancy."

Medscape: "Rheumatoid Arthritis and Pregnancy."

NIH Osteoporosis and Related Bone Diseases National Resource Center: "What People With Rheumatoid Arthritis Need to Know About Osteoporosis."

UptoDate: "Patient information: Rheumatoid arthritis and pregnancy (Beyond the Basics)."

WebMD: "Eating for Two: Your RA Pregnancy Diet."

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