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Pregnancy and arthritis have a relationship in which one can worsen the other. This article outlines the relationship between pregnancy and arthritis and the risks and benefits associated with either condition.

Arthritis is a chronic condition that can affect different joints of the body, leading to joint stiffness, swelling and pain. It is a common condition that normally affects people as they get older. However, sometimes, arthritis can develop in women of childbearing age, in which case, it is important to be diligent if you become pregnant and have arthritis. Arthritis can have an effect on pregnancy and pregnancy, in turn, can have an effect on arthritis.

Fortunately, most pregnant women with arthritis have healthy deliveries and have non-complicated pregnancies. Still, there is always a risk and therefore, you should be careful if you are a pregnant woman with arthritis.

So, what are the risks associated with pregnancy when you have arthritis?

Women with rheumatoid arthritis, one of the subtypes of arthritis, are at a higher risk of developing three different pregnancy-related complications:

  1. Premature or early delivery. Some studies have shown that pregnant women with arthritis have a higher risk a premature delivery compared to pregnant women without rheumatoid arthritis. Furthermore, one study indicated that women with rheumatoid arthritis who have severe symptoms of the disease were the most at risk for having a premature delivery.
  2. Reduced birth weight of the baby. One study indicated that women with severe symptoms of rheumatoid arthritis had the highest risk of giving birth to low birth weight babies.
  3. Preeclampsia. This is a pregnancy complication that leads to high blood pressure and high levels of protein in the urine. It can often be a dangerous condition, and delivery is the only "cure". Studies have shown that women with rheumatoid arthritis have a higher risk of developing preeclampsia compared to the general population.
Additionally, about 20 percent of women experience more severe rheumatoid arthritis symptoms during their pregnancy and need medical treatment.

There are also other risks and problems associated with pregnancy when you have rheumatoid arthritis. These include:

  • Delivery of the baby can be more difficult if the joints that are affected include the hips or the spine. In this case, discuss with your doctor potential delivery options including a c-section.
  • Some medications that are used to treat rheumatoid arthritis can actually affect pregnancy and even harm the fetus. Hence, it is vital you talk to your doctor if you are planning on conceiving as he or she may stop some medications.
  • The stress of your pregnancy may actually worsen some symptoms such as fatigue and pain of your back (if you have arthritis that affects your back).
  • You gain more weight when you are pregnant and the extra weight adds extra stress on your joints, particularly if your arthritis affects joints of the hips, spine or knees.

Arthritis: Benefits of pregnancy

Interestingly, there are also some benefits associated with getting pregnant when you have arthritis. This is because pregnant women tend to have a more suppressed immune system. Thus, about 50 percent of women with rheumatoid arthritis experience less intense symptoms during pregnancy, and therefore, have low disease activity.

Furthermore, studies have shown that women experience swelling and pain at a lesser degree when they are in their second trimester. Additionally, about 20 to 40 percent of pregnant women with rheumatoid arthritis have either very few or no symptoms by the third trimester.

So what happens when you have arthritis and become pregnant?

Your doctor will carefully evaluate your disease severity and then decide which drugs you should continue to be on. The likely scenario is that if your medication is necessary for treatment of your arthritis, then your doctor will continue your medication during your pregnancy. There is, however, the exception of the non-steroidal anti-inflammatory drugs (NSAIDs), which should not be administered in the third trimester as it makes labor longer and can lead to pulmonary hypertension. Some arthritis drugs are not (as) safe during pregnancy, so your doctor will avoid these.

So what happens after birth?

Many women with rheumatoid arthritis will go through an arthritis flare soon after birth – usually within three months. If an arthritis flare develops, then you should go see a doctor as soon as possible to manage your symptoms. Another important thing to keep in mind is that if you are breastfeeding, you should talk to your doctor about any drugs that may potentially pass through the breast milk. There are several medications that don’t pass through the breast milk so you likely won’t have a problem.

Does having arthritis affect my fertility?

In fact, it has been shown that having rheumatoid arthritis can cause difficulty when it comes to conceiving. This could be due to several things including:

  • Medication. Some medications that patients with rheumatoid arthritis take can detrimental to getting pregnant.
  • Inflammation. Patients that have inflammatory diseases tend to have a harder time conceiving.

Conclusion

Most women with pregnant arthritis will have normal pregnancies and healthy deliveries. However, it is important to diligently monitor for signs of any other diseases during pregnancy and discuss with your doctor if you should discontinue any medications.

  • Klipple, G. L., and F. A. Cecere. "Rheumatoid arthritis and pregnancy." Rheumatic diseases clinics of North America 15.2 (1989): 213-239.
  • de Man, Yael A., et al. "Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study." Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 60.11 (2009): 3196-3206.
  • Ireland, Mary Lloyd, and Susan M. Ott. "The effects of pregnancy on the musculoskeletal system." Clinical Orthopaedics and Related Research® 372 (2000): 169-179
  • Photo courtesy of SteadyHealth

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