Patient education: Rheumatoid arthritis and pregnancy (The Basics)

Can people with rheumatoid arthritis have normal pregnancies? — Yes. It is possible for people with rheumatoid arthritis (often called "RA") to have healthy pregnancies. But you will need to work closely with your doctors. They will make sure that you are doing the right things to control your symptoms and protect your baby.

What should I do before trying to get pregnant? — It is very important to talk to your doctor before you start trying to get pregnant. You will need to see an obstetrician (a doctor who takes care of people during pregnancy), your rheumatologist (the doctor who handles your RA), and your primary care doctor. They can make sure that any medicines you take are safe to use during pregnancy. They might also do some tests to make sure your body is ready for a pregnancy.

Some RA medicines can cause serious problems for a baby. You will need to stop taking these before getting pregnant:

●Methotrexate (sample brand names: Rheumatrex, Trexall) – If you take this medicine, you should stop it at least 1 month (3 months is even better) before trying to get pregnant. This medicine is very dangerous for a baby.

●Leflunomide (brand name: Arava) – If you take this medicine, you should stop it at least 2 years before trying to get pregnant. Or your doctor can give you another medicine to make the leflunomide leave your body faster. Then they can do a test to be sure it is out of your body before you try to get pregnant.

You might need to stop taking other drugs, too.

If you do get pregnant while taking methotrexate, leflunomide, or other medicines used to treat RA, tell your doctors right away. They will help you decide whether to stop (or switch) any of the medicines you are taking. Plus, they might suggest adding other treatments.

There are also steps that everyone should take before trying to get pregnant. These include things like taking vitamins and avoiding smoking, alcohol, and certain foods. Your doctor or nurse can talk to you more about general planning for pregnancy.

How will my RA affect my pregnancy and my baby? — RA does not usually cause problems with pregnancy or the baby's health. But some people with RA might not get pregnant as quickly as others. Also, some medicines used to treat RA can be unsafe for a baby.

How will my medicines affect my pregnancy or my baby? — Some RA medicines can hurt an unborn baby. You should not use these during pregnancy.

●Methotrexate can cause miscarriage (when the pregnancy ends before 20 weeks). It can also cause the baby to not develop correctly.

●Leflunomide can cause the baby to not develop correctly.

●High doses of steroids in early pregnancy can increase the risk of being born with a problem called "cleft palate." (In babies with cleft palate, the roof of the baby's mouth does not form properly.) High doses of steroids later in pregnancy can cause other problems, such as the mother's water breaking too early.

It is important to talk to your doctors about all medicines you take and follow their directions carefully. Do not start taking any new medicines, supplements, or herbal drugs without talking to your doctors first.

Some RA medicines can be taken during pregnancy, but only at certain times or in certain amounts:

●NSAIDs – These include medicines such as ibuprofen (sample brand names: Advil, Motrin), naproxen (sample brand name: Aleve), and aspirin. They can safely be used at some times during pregnancy, but not at other times.

●Steroids – These medicines, such as prednisone, are fairly safe in low doses during pregnancy. They are often used in pregnant people with RA to help keep the disease under control. (These are not the same as the steroids some athletes take illegally.)

There are other safe medicines available, too. Your doctors can help you decide how best to treat your RA symptoms without hurting your baby.

Will pregnancy affect my RA symptoms? — It might. Many people with RA notice that their symptoms get better during pregnancy. But some people's symptoms stay the same or get worse.

Some normal pregnancy symptoms are similar to RA symptoms, including:

●Feeling tired

●Swelling of the hands, feet, or ankles

●Joint pain

●Mild shortness of breath

●Numbness or pain in the hands

Even if your RA symptoms get better during pregnancy, they often get worse again after the baby is born. Your doctor will decide when to start up your regular RA medicines again.

Will I be able to breastfeed? — Yes. You can safely breastfeed if you have RA. But you will need to avoid certain medicines while you are breastfeeding. Some RA medicines can get into breast milk and be harmful to a baby.

If you want to breastfeed, talk to your doctors. They can tell you which medicines you can take and which ones to avoid. Most of the medicines that are unsafe during pregnancy are also unsafe while breastfeeding. Some people need to stop breastfeeding if they need these medicines to control their RA.

More on this topic

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