Ankylosing spondylitis symptoms often remain stable during pregnancy, but they may flare up, especially during the second trimester. This can increase your chances of cesarean delivery.

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If you live with a chronic condition like ankylosing spondylitis (AS) and are considering pregnancy, you likely have many questions and concerns.

You may want to know how the condition will affect your ability to get pregnant, your pregnancy and delivery, and whether you will be able to continue to take your medications.

Here, we take a look at what to know about AS and pregnancy, including whether you should expect a flare-up, which treatments are safe, and how to best prepare for your pregnancy if you have AS.

Ankylosing spondylitis (AS) is a chronic inflammatory condition that affects the joints in the spine and hips. Roughly 1% of the general population has it. Symptoms range from minor to severe and may come and go, flaring up in certain situations.

Symptoms of AS include:

Genetics likely cause AS, though environmental factors may also play a role. People born with the HLA-B27 gene may have an increased risk of developing AS.

Each person experiences AS differently during pregnancy. Some people have no flare-ups, while others may experience them. A 2017 study found that about 25% of people with AS experience an increase in symptoms during pregnancy.

AS may affect labor and delivery. The pressure of the baby on your back and hip joints may be uncomfortable and worsen your symptoms. Sometimes this makes vaginal birth more challenging.

At times, inflammation of the spine may make administering an epidural more difficult.

Symptoms of AS itself will not be different during pregnancy, but pregnancy may cause your symptoms to flare up.

A 2018 study that included 179 pregnancies found that flare-ups were most likely to occur in the second trimester, with 45% of study participants experiencing a flare-up during that time period. These increased symptoms were remarkably lower at 6 weeks postpartum.

Overall, mental health was stable among study participants, but mental health was notably better 6 weeks postpartum than during the first trimester of pregnancy.

One of the challenges of AS and pregnancy is figuring out which medications are safe and what alternatives are available.

If you’re planning to get pregnant, begin these discussions with your healthcare team as soon as possible. If you’ve recently become pregnant, it’s important that you promptly discuss which medications are safe for you to continue taking.

Medications that are safe during pregnancy

According to 2020 guidance from the American College of Rheumatology, the following medications for people with rheumatic conditions are safe during pregnancy:

Medications that have precautions during pregnancy

According to the same 2020 guidance, the following medications for people with rheumatic conditions have specific limitations on when they may be taken during pregnancy:

Medications NOT recommended during pregnancy

The following medications and treatments are not recommended to take during pregnancy, according to the American College of Rheumatology:

It’s not possible to know for sure whether your AS symptoms will remain stable or flare up during pregnancy.

A 2017 study found that discontinuing certain medications in early pregnancy increased the risk of experiencing a flare-up during pregnancy.

This is why it’s best to discuss any medication changes in detail with your healthcare team. Together, you can consider alternative medications if your preferred medication is not recommended during pregnancy.

The best way to prepare for pregnancy is to have discussions with your healthcare team before becoming pregnant. If your pregnancy was unexpected, connect with your doctor as early as possible.

Items to discuss include medications during pregnancy and how AS may affect your pregnancy, labor, and delivery.

You may also want to discuss postpartum plans and how having AS may affect your ability to breastfeed or care for your baby.

Most people with AS will be able to have a healthy and successful pregnancy. However, people with the condition may have more complicated labor and delivery.

For example, labor and delivery may exacerbate your back and hip pain. Inflammation in your spine may make administering an epidural more challenging.

People with AS are more likely to have cesarean deliveries and may be more likely to experience preeclampsia and preterm birth.

Will I pass ankylosing spondylitis to my baby?

AS has a genetic component, so it’s possible your child may develop it. However, most children will not develop the condition.

Can I exercise during pregnancy?

Exercise and physical therapy are important parts of treatment for many people with AS. Most types of exercise can continue during pregnancy.

Talk with your doctor about whether any exercises you are considering are safe during pregnancy.

Does ankylosing spondylitis affect your ability to get pregnant?

According to the Arthritis Foundation, having AS should not affect your ability to conceive. However, high levels of inflammation may affect conceiving, so it’s important to work with your healthcare team to lower and manage any inflammation.

While some people with AS experience flare-ups during pregnancy, most people have uneventful and healthy pregnancies.

The condition may make labor and delivery more difficult and may increase your chances of cesarean delivery.

If you have any questions or concerns about AS and pregnancy, don’t hesitate to reach out to your healthcare team.