How Rheumatoid Arthritis Affects Pregnancy

Medically Reviewed by Traci C. Johnson, MD on September 02, 2014
4 min read

If you're pregnant or planning to be, you may wonder how having rheumatoid arthritis (RA) could affect your pregnancy. Here's some good news: Many women with RA find that their symptoms go into remission during pregnancy. What’s more, RA doesn't seem to affect your chances of getting or staying pregnant. However, certain RA medicines aren't safe to take while you are pregnant. Here's what you need to know about pregnancy and RA.

Researchers aren't 100% sure why pregnancy may cause RA to go into hiding, but they have several theories. RA is caused when the body’s immune system goes haywire and attacks its own healthy tissues and organs. Researchers believe that pregnancy may dampen your immune system to keep your body from seeing your baby as a "foreign" invader. This means that your immune system doesn't work as actively as it did before, leaving you with less inflammation and pain.

Unfortunately, not all women with RA are free from joint pain during pregnancy. Some women don’t improve while they're expecting, and some may have flares.

About 40% to 50% of pregnant women with RA need drug treatment. Experts say pregnant women can safely take the steroid prednisone during the second and third trimester of pregnancy and while breastfeeding. Experts also consider Plaquenil (hydroxychloroquine) safe to take while pregnant. Enbrel (etanercept) is also sometimes used in the 2nd and 3rd trimesters.

The best way to ensure a healthy pregnancy and healthy baby is the same whether you have RA or not. Like all pregnant women, you should:

  • Eat a healthy diet.
  • Gain the recommended amount of weight.
  • Exercise if your doctor says it's OK.
  • Avoid tobacco and alcohol.
  • Get regular prenatal care.

Because you have RA, you need to take a few special precautions during your pregnancy.

Prednisone and pregnancy risks. Taking prednisone in the second or third trimester won't harm your baby, but this steroid may increase your risk of high blood sugar and high blood pressure, so your doctor will keep an even closer eye on your levels. High blood pressure in pregnancy is a risk factor for preeclampsia, which can be life threatening. High blood sugar may mean gestational diabetes, which can increase your risk, and your baby's, for a number of health problems. See your doctor for regular prenatal care to help find and treat any problems early.

Prenatal vitamins and steroids. Taking a good prenatal vitamin is essential for all pregnant women. But when you take prednisone your risk of bone loss increases, so you may need more calcium and vitamin D (which you need to absorb calcium) than is found in a prenatal vitamin. Talk with your obstetrician or rheumatologist to make sure you are getting enough of these two nutrients.

Safe fish oil supplements. If you take fish oil to fight inflammation, check with your doctor to make sure you take supplements that are mercury free and won't harm your baby.

Risks of gum disease. Research has shown that people with RA are more than twice as likely to have gum disease, and gum disease has been associated with preterm labor. So see your dentist for regular cleanings.

Many women go into remission during pregnancy and continue to do well after their baby is born. Other women find that their RA symptoms flare in the months after delivering their baby. Flares are a particular concern for women who are breastfeeding since medicines travel through breast milk to your baby.

If you're breastfeeding, you may not be able to take the same medicines that you took before you were pregnant, such as methotrexate and biologics. You can safely take certain medicines to help calm inflamed joints during a postpartum flare. If pain and inflammation become too much, talk with your doctor about your options.