“Can I still get pregnant?”
It’s a question that many young women understandably ask when they are diagnosed with a chronic incurable illness like rheumatoid arthritis.
Arthritis may not seem like a condition that would have any impact on family planning, but, in fact, rheumatoid arthritis (RA) can warrant additional concerns among patients who are looking to get pregnant and start a family.
While it is an oft-repeated adage that rheumatoid arthritis goes into remission during pregnancy, that isn’t always the case.
Women also may not stay in remission during the entire pregnancy.
The Arthritis Foundation estimates that 70 percent of women go into remission during the second trimester of pregnancy. Often, if they remiss during the second trimester, they will also have reduced symptoms through the third trimester and sometimes up to eight weeks after childbirth.
While there are some women who stay in remission long term, many women do find that their RA eventually returns after having their baby.
And for some of the 30 percent of women who do not experience remission, RA symptoms may actually worsen.
This is because certain rheumatoid arthritis medications must be discontinued leading up to and during pregnancy due to safety concerns.
A portion of these drugs must also be halted during breastfeeding.
Being off of these medications long term can have a negative impact on RA symptoms, particularly for those women who didn’t experience any remission or lessening of disease activity.
The Arthritis Foundation says it’s imperative that women with RA speak to their doctors before conception if a pregnancy is being planned.
At this juncture, patients can learn which drugs may be harmful and how to best proceed in a way that is healthy for both mother and baby.
More than just childbirth
When it comes to family planning, concerns go beyond childbirth.
While fertility and low birth weight can be a concern, mothers and fathers with RA have to also be prepared to care for and raise their child — even when they are not feeling well themselves.
After all, RA flares will not stop just because there is a new baby in the house.
Even if a pregnancy is unexpected, there are resources in place to help new parents navigate life.
Two recent studies have shown that women living with RA may lack credible and reliable information and resources for making decisions relating to reproductive health and/or family planning.
These studies along with six others (which have been conducted in partnership with the ArthritisPower research registry developed by CreakyJoints) were presented during the 2017 American College of Rheumatology Annual Meeting, which was held in San Diego.
One of the issues that RA patients wanted addressed was the impediments to family building and risks of contraception.
Researchers from Duke University and CreakyJoints said that 59 percent of women with inflammatory arthritis surveyed had fewer children than they desired.
They also found that the most common fears that limited family size were:
- being unable to care for a child (85 percent)
- arthritis medications potentially harming a child (61 percent)
- a child also developing arthritis (52 percent)
Patients, doctors, and researchers alike were also concerned about women possibly taking methotrexate and similar drugs during pregnancy while not using proper or effective contraceptive measures.
The use of methotrexate doing pregnancy often increases the risk of miscarriage or birth defects.
As far as contraception goes, a recent study showed that long-term birth control pill usage could help stave off RA symptoms — but it isn’t necessarily a cure-all.
Getting the word out
All of these are concerns and can pose a risk to RA patients planning for a pregnancy.
In a press statement, Dr. Megan E.B. Clowse, MPH, a rheumatologist at Duke School of Medicine who led the research team on the latest studies, said that the findings of these studies show that, “Women with arthritis really worry about pregnancy and the impact that their disease and medications might have on their children. It is also clear that many of them aren’t informed about the current data and would benefit from better education and communication tools that specifically address these issues. My goal is to help women build the families that they want, and this study demonstrates that many women with arthritis aren’t there yet.”
Her colleague, W. Benjamin Nowell, PhD, director of patient-centered research at CreakyJoints, principal investigator of ArthritisPower and a co-investigator on the reproductive concerns studies, said in the same statement, “Our study demonstrates that more research is needed to better understand how women seek to balance inflammatory arthritis treatment with family planning. In the meantime, CreakyJoints has collated the most up-to-date research and educational content about family planning for people living with autoimmune arthritis in the latest edition of our patient guidelines series. The new booklet seeks to help families ask informed questions of their doctors and make well-advised decisions.”
CreakyJoints has published a free downloadable resource on their website’s patient guidelines section about family planning and reproductive health with rheumatoid arthritis.
Rheumatoid arthritis patient, advocate, and blogger Stephanie Aleite of The Young Face of Arthritis recently appeared on the Dr. Phil Show with Dr. Freda Lewis-Hall, the chief medical officer of Pfizer, to discuss family planning with rheumatoid arthritis.
They explained that despite some valid concerns, medical advances are making it easier for women with RA to get pregnant, stay pregnant, bear children, and have a family of their own.
Ann-Marie Kenna, an RA patient from Australia, told Healthline, “Both pregnancies with my boys, I went into remission, which was so lovely. My pregnancy with my daughter was tough, as I didn’t go into remission and my arthritis was active in so many joints. But postpartum was easier as the disease was already controlled, whereas with the boys I flared instantly postpartum.”
Natalie Gardner of the United Kingdom told Healthline, “My first pregnancy was a breeze, like I didn't have any medical conditions at all. I did flare almost immediately after the birth though, which was tough. Unfortunately, with my youngest I flared during pregnancy and ended up on steroids to keep my symptoms at bay.”
Carolyn Walker Smith of Pennsylvania told Healthline that she went into remission with both of her pregnancies, although her disease is active now and her children are grown.
And Danielle Pumlilia of Washington State told Healthline that “Most who have RA go into remission while pregnant. Mine, unfortunately, didn’t.”
Every patient is different, which makes it even more crucial to have resources to turn to and a plan in place for thinking about and talking about pregnancy and beginning a family.