Brunilda Nazario, MD
Here's some good news: If you have RA, you may not be plagued by joint pain and inflammation during your pregnancy. For many women, RA tends to go into remission during pregnancy. What’s more, RA does not seem to affect your chances of getting or staying pregnant, the way other autoimmune diseases such as lupus may.
Researchers are not 100% sure what it is about pregnancy that makes RA go into hiding, but several theories are bandied about. One is that pregnancy dampens your immune system. Changes in your immune system during pregnancy prevent your body from seeing the baby as a "foreign" invader. This means that your immune system doesn't work as actively as it did before. RA and other autoimmune disease are caused when the body’s immune system goes haywire and attacks its own healthy tissues and organs.
This is not to say that pregnancy will be a honeymoon from joint pain for every woman with RA. Some woman don’t improve while they're expecting, and some may suffer flares.
“Some form of drug treatment may be necessary in 40% to 50% of pregnant women with RA, but they usually get by with low-dose steroids or the antimalarial Plaquenil [hydroxychloroquine], both of which are considered safe during pregnancy and while breastfeeding,” says Elaine Husni, MD, vice chairwoman of rheumatology and director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic in Ohio.
Although RA may go into remission, don't be surprised if you have some aches and pains during pregnancy. That doesn't necessarily mean you're having a flare, says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn. “Don’t panic and think it’s a flare -- it could just be a part of pregnancy,” she says.
"The flip side is that RA may flare in the months following delivery,” Husni says. "Again, this is not a given, many women do well in the postpartum period."
If you are thinking about breastfeeding, there are certain medications that can be used safely to help cool inflamed joints during a postpartum flare. But some of your rheumatologists’ bigger guns, such as methotrexate and biologics, cannot be used while breastfeeding.
If the pain and inflammation becomes overwhelming, “we can always initiate other medications back postpartum, but it takes a while for them to begin working,” Amin says.
The best way to ensure a healthy pregnancy and baby is the same whether you have RA or not. For starters, eat a healthy diet, don't gain too much weight, exercise if your doctor says it's OK, don’t smoke or drink alcohol, and avoid fish with high levels of mercury. If you take fish oil to fight inflammation, check with your doctor to make sure you take supplements that are mercury free.“Good prenatal care is essential for all pregnant women,” says Amin.
“A good prenatal vitamin is essential, and if you are taking prednisone, you are at higher risk of bone loss, so you may need more calcium and vitamin D,” she says. Talk to your obstetrician or rheumatologist to make sure you are getting enough.
While prednisone is safe during pregnancy, it may increase an expectant mom's risk of high blood sugar and high blood pressure, so your doctor will keep a close eye on your levels. High blood pressure in pregnancy is a risk factor for preeclampsia, which can be life threatening. High blood sugar may mean gestational diabetes, which can increase the risk of cesarean section delivery.
In these cases, being forearmed is being forewarned. Regular prenatal care will help identify problems early – when there is more chance to intervene, she says.
Another important part of prenatal care is regular dental cleanings. Research has shown that people with RA are more than twice as likely to have gum disease, and gum disease has been associated with preterm labor.
Don’t fret about passing your RA on to your children. Autoimmune diseases do tend to cluster in families, and there are clearly some genes that predispose a person to develop RA, but “we can’t say you are transmitting something to your child if you have RA,” Husni says.
The bottom line? “Most women with RA and their babies do very well, during pregnancy and afterward,” she says.
SOURCES:Elaine Husni, MD, MPH, vice chairwoman of rheumatology; director, Arthritis and Musculoskeletal Center, Cleveland Clinic, Ohio.Shreyasee Amin, MD, rheumatologist, Mayo Clinic, Rochester, Minn.
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