Kevin P. White, MD, PhD, is a retired chronic pain specialist who is still active in research, teaching, and public speaking. He is a five-time international award-winning author of the landmark, best-selling book “Breaking Thru the Fibromyalgia Fog – Scientific Proof Fibromyalgia Is Real.” He continues to be a tireless fibromyalgia patient advocate.
Fibromyalgia is a multi-systemic disease. Because of this, there are several reasons to be concerned about its effects on pregnancy.
- the nervous system and muscles
- the immune system
- a number of different hormones
- autonomic nerve control of the skin, heart, blood vessels, gastrointestinal tract, and bladder
Symptoms such as persistent, widespread pain and severe fatigue that usually lasts years — if not indefinitely — characterize this disease.
Fibromyalgia is the disease of a million myths, because of all the misunderstandings, half-truths, and untruths that exist about it. One of these myths is that it’s strictly a middle-aged and older women’s disease. However children and men get it too. And more than half of women with fibromyalgia are under age 40, still in their reproductive years.
Not every pregnant woman’s experience with fibromyalgia will be the same. However, all women typically experience an increase in pain, especially over the last few months of pregnancy. This is when even healthy women tend to experience more discomfort.
At this point in a pregnancy:
- The woman is gaining weight rapidly.
- The baby’s growth is accelerating.
- There is increased pressure on the low back, which is often a problematic area for people with fibromyalgia.
On the other hand, chemicals like relaxin are released in the body during pregnancy. Among other things, they help to relax muscles. This may have some beneficial effect. However, overall, the average woman with fibromyalgia will notice a significant increase in her pain. This is especially true over the last few months and particularly in the low back and hip areas.
This question has two parts. First, you have to understand how fibromyalgia affects the likelihood of pregnancy. Though there has been little research in this area, there’s no evidence that fibromyalgia negatively affects how fertile a woman is. However, many women (and men) with fibromyalgia experience discomfort during sexual activities. This may cause them to engage in sexual activities less frequently.
Once a woman becomes pregnant, fibromyalgia can affect the pregnancy itself. For example, one study observed 112 pregnant women with fibromyalgia in Israel. Results found that these women were more likely to have:
- smaller babies
- recurrent miscarriages (roughly 10 percent of the women)
- abnormal blood sugar
- excessive amniotic fluid
However, they were also less likely to have babies who were born prematurely. And they weren’t more likely to require a C-section or any special procedures.
Very few medications are approved for use during pregnancy, regardless of the condition they’re being used to treat. Some drugs are purposefully not tested in pregnant women. As such, there is little research about their effects on pregnancy.
The traditional wisdom that most doctors follow is to discontinue as many medications as possible while a patient is pregnant. This certainly is true for fibromyalgia. Does this mean that a woman must stop all her fibromyalgia medication? Not necessarily. What it does mean is that she must discuss with her doctor the various benefits and risks of either stopping or continuing each medication she’s taking.
Fortunately, medications are not the only treatments proven effective for fibromyalgia. Stretching, meditation, yoga, and deep heat ointments may help. Massage also may be helpful, as long as it’s not too aggressive.
Pool therapy or sitting in a hot tub may be particularly soothing — especially for those with back pain and in the late stages of pregnancy. Exercise is important as well, but it must be tailored to individual ability and endurance. Being in a pool during exercise may help.
Rest is crucial. Even healthy pregnant women often find the need to sit or lie down to relieve pressure on their back and legs. Schedule 20- to 30-minute breaks throughout the day. You to take leave from our job earlier than you intended in order to get enough rest. Your family, doctor(s), and employer all should support you in this health-related decision.
You may expect women with fibromyalgia to have more pain during labor and delivery than women without the condition. However, no evidence suggests a significant difference. This makes sense, given that spinal blocks can now be administered to effectively relieve pain over the last few crucial hours of labor.
As mentioned earlier, fibromyalgia doesn’t appear to result in premature deliveries or more C-sections. This indicates that women with fibromyalgia ultimately tolerate labor as well as other women.
It’s widely believed that a woman’s fibromyalgia will continue to be worse for a period of time after giving birth. Fibromyalgia sufferers typically have very disrupted sleep. And research has shown that the worse they sleep, the more pain they have, especially in the morning.
It’s no coincidence that the mother’s fibromyalgia generally doesn’t start returning to baseline until after the baby starts sleeping better. It’s also crucial that a mother’s mood is followed closely, since post-partum depression can be missed or misinterpreted as fibromyalgia.
Once you’ve decided that pregnancy is something both you and your partner want, make sure that you have the proper support in place. It’s crucial to have a doctor who listens, a therapist to turn to, a supportive partner, help from friends and family members, and access to a warm pool. Some of this support may come from your local fibromyalgia support group, where you may find women who have already gone through pregnancy.
Breastfeeding is ideal for the child, but you may need to choose to bottle feed if you have to go back on medications to manage your fibromyalgia symptoms.
There is no evidence to suggest that going through a pregnancy will make your fibromyalgia worse beyond the first six or so months after delivery. By then, you should have been able to resume any medications that had been controlling your symptoms. However, you will continue to require the support of your partner and family and friends, just as all mothers do.