“The worry comes from uncertainty about how a woman’s rheumatic condition will affect the pregnancy as well as how pregnancy will affect her rheumatic condition. If a woman who has arthritis is considering getting pregnant, know what pregnancy advice applies to the condition. “says Dr Kholoud Mohamed, Head of Rheumatology Unit, Farwaneya Hospital. Although anyone can get rheumatoid arthritis, women with RA outnumber men by about three to one. Many women with rheumatoid arthritis are diagnosed in their 20s and 30s, just when marriage and family start to take life’s center stage.
In many women with RA, disease activity improves substantially during pregnancy. However, some women’s RA flares up or remain’s active during pregnancy. Thus, it is often necessary to change or modify treatment of RA during pregnancy to control flares while minimizing the risks of RA treatments to the developing fetus.
It is imperative to tailor a treatment regimen that stabilizes the woman’s disease prior to conception, using medications that are safe to continue throughout pregnancy and the post-partum period.
Changes in Rheumatoid Arthritis during pregnancy
Many changes to the immune system occur normally during pregnancy. These changes enable a fetus to grow and develop. Some of these changes contribute to the improvement of RA symptoms during pregnancy.
Disease activity during pregnancy
Rheumatoid arthritis itself doesn’t seem to harm the developing baby, even if RA is active during pregnancy. In fact, 70% to 80% of women with RA have improvement of their symptoms during pregnancy. Although some women with RA may have a slight risk of miscarriage or low-birth-weight babies, the vast majority of women have normal pregnancies without complications. “Unfortunately, the disease intensifies in 90% of women post-partum of 3-4 months, so these women are advised to have constant follow ups with their rheumatologist.” commented Dr Kholoud.
It is sometimes difficult to distinguish between the common discomforts of pregnancy and the symptoms of RA. Pregnancy discomforts that are similar to those of RA include the following:
* Fatigue
* Swelling of the hands, feet, or ankles
* Joint pain, especially in the low back
* Shortness of breath
* Numbness or pain in one or both hands (caused by carpal tunnel syndrome of pregnancy)
Pregnancy outcome
Most reports show that there is no increase in stillbirth or miscarriage in women who have RA. However, some medications, particularly high-dose steroids, may increase the risk of having a smaller than normal infant and may increase the risk of premature rupture of the membranes.
Rheumatoid Arthritis Treatment during pregnancy
Some women with RA flare during pregnancy and require treatment. However, some medications used in the treatment of RA can be harmful to the fetus. The benefit of any medication must be balanced with the potential risk.
Medical observation crucial in pregnancy
With close observation and proper medical management, women with arthritis or other rheumatic conditions can have successful pregnancies. It’s important for pregnant women with arthritis to be under the care of both an obstetrician to manage their pregnancy and a rheumatologist to manage their rheumatic condition. Successful pregnancies are possible with the team approach but not every pregnancy will be without complications.
For some patients, the benefits of the drug in controlling disease and in maintaining function may outweigh the possible risks to the mother or to the fetus. The use of any medication for arthritis during pregnancy is, thus, a matter that a patient and her rheumatologist should discuss, so that potentially dangerous medications can be avoided and the individual risks and benefits of any other drug can be carefully weighed.
Rheumatoid Arthritis after delivery
Approximately 90 percent of women with RA experience a flare during the postpartum period, usually within the first three months and particularly after a woman’s first pregnancy .Many experts recommend restarting RA medications in the first few weeks after delivery.
“With the right treatment and prenatal care, babies born to moms with rheumatoid arthritis are as healthy and happy as any.” added Dr Kholoud.
