Some experts say the children of women with rheumatoid arthritis can develop autoimmune diseases themselves. Others say the risk is overstated.
Mothers-to-be often have enough to worry about.
Now, pregnant women with rheumatoid arthritis may have an added concern: lifelong health effects on their children.
Some women with rheumatoid arthritis (RA) say they feel wonderful during and after pregnancy, even occasionally going into remission.
However, a recent study published in the Annals of the Rheumatic Diseases concluded that the children of mothers with rheumatoid arthritis may actually have a different DNA “methylation profile” than children who are born to women without RA.
And this isn’t the first study of its kind, either.
“Maternal rheumatoid arthritis during pregnancy is associated with differential DNA methylation in offspring,” Dr. Hilal Ince-Askan, a rheumatologist from the Erasmus Medical Center in the Netherlands and lead study author, said in a press statement. “Maternal rheumatoid arthritis might have lifelong consequences for the offspring.”
What kinds of lifelong consequences? Primarily DNA differences.
For instance, some RA drugs such as prednisone and other corticosteroids as well as sulfasalazine (azulfidine) can affect the methylation of DNA.
How this affects an individual depends on where this activity is located in the genome.
In the study, the most severely impacted areas — or parts of DNA — were found to be associated with conditions such as insulin sensitivity, heart failure, and diabetes.
Other areas affected by these RA medications can at times be associated with heart attack, atrial fibrillation, coronary heart disease, obesity, and type 2 diabetes.
But is it from the RA or the drug? And when does methylation occur?
DNA methylation often occurs early in pregnancy.
If a mother is known to have RA, some doctors will advise halting certain drugs, especially during the first trimester or even afterward while breastfeeding.
Some of the drugs carry an FDA label advising against use during pregnancy.
The researchers on this study and others like it caution that it remains unclear whether these preliminary associations are linked.
The researchers also couldn’t strictly determine whether the DNA methylation was caused by the actual disease itself or the RA treatments.
The researchers do recommend that the potential effects and impacts of both rheumatoid arthritis disease activity and the use of standard and high-risk RA medications should be investigated further.
Some women shared their experiences with Healthline.
“I have JA (juvenile arthritis) and have four children. One has JA, two have Hashimoto’s,” said Laura Pride Boslaugh of Missouri.
Courtney Juarez’s children also have some medical issues. The family lives in Las Vegas, Nevada.
“I have lupus with mild arthritis and my daughter who is now 14 has [had] juvenile arthritis since age 5,” Juarez told Healthline. “I now have a son who is almost 2. No diagnosis, but this past month he says [his] knee hurts. So not sure yet with him”
Aside from passing on autoimmune issues, there are other considerations that women with RA should bear in mind if they become pregnant.
Some studies show that mothers with RA often have smaller babies than average and that mothers with RA are more likely to have hypertension during pregnancy.
It’s also been found that children born to mothers with RA are more likely to have chronic diseases such as epilepsy.
There are also some concerns about pregnancy and family planning among people with RA.
A fact sheet from the nonprofit MotherToBaby published this year states that rates of miscarriage among RA moms in relation to the general population are similar, but that mothers with RA have other concerns such as high-risk medication use, preterm delivery, and the possibility that it might be harder to get pregnant.
The fact sheet also notes that there’s not much data on fathers with RA and how their condition might affect children.
But is it all bad news?
Not all doctors are convinced.
Dr. Charles H. Weaver of OMNI Health Media, who specializes in oncology and rheumatology issues and is chief executive officer of a series of websites including theRAconnection and CancerConnect, doesn’t think these kinds of studies raise much of a concern at all.
“I’m sorry to say that I am simply not sure what to say about this — it seems to me that publishing this data simply raises unnecessary and unanswerable concerns for women with RA who are considering pregnancy,” Weaver told Healthline.
Some people with RA feel the same way.
Carolyn Walker of Western Pennsylvania told Healthline that neither of her children have significant health issues.
“I had RA with both. No health problems (for either child).” she said.
Positivity and hope can go a long way, too.
Just ask Lindsay Wright of Winnipeg, Manitoba, Canada, who was diagnosed with juvenile rheumatoid arthritis — now called juvenile idiopathic arthritis or just juvenile arthritis — as a child and watched her own child surpass her age of diagnosis free of chronic pain and illness.
“I was diagnosed with juvenile arthritis at 10, and was pregnant with arthritis,” Wright said. “I’ve done basically everything with arthritis. This year, my daughter was 10. I didn’t think I lived with any real arthritis-related fear for her, but I’ve been surprised and overwhelmed by the whirlwind of emotions I’ve felt this year as I’ve witnessed her passing my diagnosis age/milestone.”
“Watching her grow up healthy and disease-free is quite literally my greatest joy — and my most heartfelt prayer,” she said.