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Family Planning and Rheumatoid Arthritis

Medically Reviewed by Minesh Khatri, MD on September 17, 2019

Although anyone can get rheumatoid arthritis, women with RA outnumber men by about 3 to 1. Many women with rheumatoid arthritis are diagnosed in their 20s and 30s, just when marriage and family start to take life's center stage.

With pain, fatigue, and medication side effects to consider, there's no question that rheumatoid arthritis makes family planning more complicated. But it doesn't have to put your dreams out of reach. If you're thinking about starting a family while living with rheumatoid arthritis, consider these tips.

Don't Worry That Rheumatoid Arthritis Could Hurt Your Baby

Rheumatoid arthritis itself doesn't seem to harm a developing baby, even if it’s active during pregnancy. In fact, 70% to 80% of women with RA have improved symptoms during pregnancy. Although some women with RA may have a slight risk of miscarriage or low-birth-weight babies, the vast majority have normal pregnancies without complications.

However, many drugs for rheumatoid arthritis -- including methotrexate (Otrexup, Rheumatrex, Trexall) and leflunomide (Arava) -- can cause birth defects. They may also cause birth defects if taken by men who father children. It's important to talk to your doctor about whether to change your treatment several months before you try to conceive.

With the right treatment and prenatal care, babies born to moms with rheumatoid arthritis are as healthy and happy as any others.

Have Patience as You Try to Get Pregnant

Experts disagree on whether rheumatoid arthritis reduces fertility in women or men. It's true that many women with RA take longer to conceive. Uneven ovulation, lowered sex drive, or having sex less often due to pain and fatigue are possible reasons.

For men, acute flares of rheumatoid arthritis temporarily reduce sperm count and function, and they can cause erection problems and lower sex drive. For both men and women, effective treatment for RA improves sexual symptoms and function. With the right treatment, fertility in most men and women is probably normal.

Know That the Future Looks Bright for Rheumatoid Arthritis Treatment

New biologic drugs for RA have created a new era of treatment for rheumatoid arthritis, according to rheumatologists. With early and aggressive treatment, most people with RA can avoid joint deformities and major disability. For most women, that means being present and active throughout your children's years at home.

Change Your RA Treatment Well Ahead of Pregnancy

As soon as you're considering starting a family, talk to your rheumatologist. Some drugs need a monthslong "washout" period before you try to conceive. That goes for men as well as women; research isn’t definite, but methotrexate might result in sperm problems that could cause birth defects.

If you're taking leflunomide, you’ll need even more planning. Due to its long half-life, leflunomide needs to be stopped 2 years before you try to conceive, although there are ways to "wash" it out of your system quicker.

Until You're Ready to Get Pregnant, Use Contraception

Again, with the potentially harmful effects of some drugs, it's important to avoid pregnancy until you're ready. Used properly, a variety of methods are appropriate and effective, such as:

Although controversial studies have suggested that oral contraceptives might prevent rheumatoid arthritis in some women, there is no evidence that they help control symptoms.

Work With Your Doctor on Rheumatoid Arthritis Treatment During Pregnancy

Your rheumatologist will help you decide on a treatment plan that includes control of your RA symptoms and safety for your baby.

Low-dose prednisone, for example, is generally considered safe during pregnancy. Hydroxychloroquine (Plaquenil) and sulfasalazine are also considered safe. While evidence is limited for biologic medicines like etanercept (Enbrel), etanercept-szzs (Erelzi), infliximab (Remicade), and infliximab-abda (Renflexis) or infliximab-dyyb (Inflectra) biosimilars, many rheumatologists are confident in their relative safety during pregnancy.

One way to avoid the risk of pregnancy problems from RA medications is to simply not take any. Under a doctor's supervision, some women quit RA drugs "cold turkey" when they begin trying to conceive.

This method has its own risks, of course: possible progression of joint damage from flares during the time when you are off treatment. But some rheumatologists endorse this approach in certain women, with close monitoring for disease activity.

Expect Improvement in Rheumatoid Arthritis Symptoms During Pregnancy

Pregnancy usually has a positive effect on rheumatoid arthritis symptoms. 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 they’ll stay mild through the rest of your pregnancy.

Many women can reduce or even stop taking drugs for RA during pregnancy. For about a quarter of women, though, rheumatoid arthritis activity continues during pregnancy or gets worse.

Unfortunately, the respite from RA symptoms is short-lived. Most women have flares after delivering their babies.

Managing RA During and After Pregnancy

Here are some things to keep in mind during your pregnancy and in the weeks and months that follow:

  • Watch weight gain. Even if your RA goes into remission during pregnancy, the added weight on your body puts more pressure on your joints. Make an effort not to gain more than your doctor recommends.
  • Get your vitamins. You may need more calcium and vitamin D to help prevent the bone thinning that some RA drugs may cause. Ask your doctor about taking supplements to protect your bones. If you're breastfeeding, you may need to keep taking them after you give birth.
  • Exercise after giving birth. It can be hard to find the time and energy to exercise when you have a newborn, but doing so can help you keep a healthy weight, which is good for your joints. Exercise can also help ease joint stiffness and pain.
  • Eat a heart-healthy diet. RA puts you at higher risk of heart disease. This makes it especially important to make heart-healthy food choices during pregnancy. Experts recommend a low-fat diet that is high in carbohydrates and fiber. This means 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

Sources

SOURCES:

Scott Zashin, MD, rheumatologist; spokesperson, American College of Rheumatology.

eMedicine.com: "Rheumatoid Arthritis and Pregnancy."

Medscape: "Pregnancy, Fertility, and Contraception Risk in the Setting of Chronic Disease,” "Rheumatoid Arthritis and Pregnancy."

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

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