Women with arthritis often find themselves questioning if the disease could hamper their baby's development and or cause trouble during their pregnancy period. Although arthritis can make you feel more pain, it does not affect your ability to get pregnant. We spoke to our expert Dr Hira Mardi, Consultant - Obstetrics and Gynaecology, Manipal Hospital Varthur Road and Whitefield, Bengaluru, who explained the impact of arthritis during and after pregnancy and how to manage this health condition.
Effects of Arthritis on Pregnancy
Disease Activity and Pregnancy
Arthritis, a condition characterised by joint inflammation, raises concerns for pregnant women regarding its potential effects on both maternal health and foetal development.
“Around 50-70% of women diagnosed with Rheumatoid Arthritis (RA) typically experience a decrease in disease activity during pregnancy. This reduction commonly begins in the first trimester and can persist for several weeks or months into the postpartum period. However, approximately half of these patients may encounter a flare-up during the postpartum phase, often occurring within the initial three months”, said Dr Mardi.
Additionally, there might be an elevated risk of developing RA within the first three months postpartum, especially following a woman's initial pregnancy.
Also Read: Arthritis During Pregnancy: Expert Lists Symptoms And Management Tips
Pregnancy Outcomes
Regarding pregnancy outcomes, RA does not appear to heighten the likelihood of foetal losses. However, RA patients may have a higher incidence of intrauterine growth restriction, pregnancy-induced hypertension, and caesarean delivery compared to the general population, added Dr Mardi.
According to the Arthritis Foundation, if arthritis impacts your back or hips, you might experience heightened discomfort in these joints as your baby develops, exerting increased pressure on them. Unless there are deformities in your pelvic area, RA generally shouldn't hinder your ability to undergo a standard vaginal delivery.
Management of Arthritis Medications During Pregnancy and Breastfeeding
Navigating the use of medications for arthritis management before, during, and after pregnancy requires careful consideration to ensure maternal health and infant well-being. Here are some considerations for managing chronic medications during this crucial period, as listed by the expert:
Glucocorticoids Use
- Patients using glucocorticoids can typically continue or initiate glucocorticoid therapy throughout pregnancy and breastfeeding, using the lowest effective dose for disease management. Non Fluorinated glucocorticoids like prednisone, prednisolone, and methylprednisolone are generally safe during pregnancy and breastfeeding when used at low to moderate doses. However, prednisone doses exceeding 10 mg per day (or an equivalent glucocorticoid) may be linked to preterm birth.
- Fluorinated glucocorticoids require close monitoring due to their potential to cross the placenta.
Traditional Synthetic DMARDs
- Stop methotrexate before and after pregnancy.
- Avoid pregnancy on leflunomide until undetectable levels.
- Hydroxychloroquine, azathioprine, and sulfasalazine are safe during pregnancy and breastfeeding.
Also Read: Preventing Preterm Birth: Expert Explains Strategies To Ensure Full-Term Pregnancy
Biologic DMARDs
- Tumour necrosis factor inhibitors are generally safe until the first two trimesters, with considerations for discontinuation in the third trimester due to infection risks.
- Certolizumab is safe throughout pregnancy due to PEGylation.
Medication Use During Breastfeeding
- NSAIDs are generally acceptable during breastfeeding, except for aspirin, which should be avoided.
- Prednisone can be used in low doses, with precautions taken regarding nursing schedules.
- Biologic DMARDs, such as TNF inhibitors, hydroxychloroquine, and azathioprine may be considered if symptoms recur postpartum.
According to a 2024 study, the postpartum phase often sees a resurgence of Rheumatoid Arthritis (RA) symptoms in women, making it challenging to determine if breastfeeding exacerbates this risk. Nonetheless, breastfeeding offers numerous advantages for both mothers and infants. Hence, women with RA who desire to breastfeed are encouraged to proceed with it.
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your expert if you face any health issues to get the necessary treatment.]