Can You Have A Baby?
Planning for pregnancy with arthritis poses big challenges to many women as not only do they have to worry about the chances of getting conceive but also the risk of miscarriage or newborn complications. As such, most women tend to drop off the idea of getting pregnant and family planning. For others, they are totally in a dilemma and keep ponder on some of the questions such as “Can I still have a baby with arthritis”, “Does arthritis affect my baby”, “Am I able to take care of the baby”? In fact, there is no definite answer to these questions.
If you have chronic arthritis, it depends on the state of your overall general health being, the severity of arthritis, the degree of mobility as well as the medications involved. Usually, the ideal time to try for a baby is when your arthritis condition is at a good or remission phase. This is because you can reduce the intake of medications which may lower your chances of getting pregnant. However, before you make any decision, you should highlight your intention of conception and discuss with your doctor.
What Are The Considerations Before Planning For Pregnancy?
Generally, prior to getting pregnant, you have to stop certain immuno-suppressants (Used to treat inflammatory and autoimmune conditions) medications that will probably cause miscarriage or birth defects. Medications including cyclophosphamide, leflunomide, chlorambucil, methotrexate and warfarin may have to stop several months or even up to a year before you can plan for pregnancy.
As such, you must check with your doctor whether your arthritis condition is under control and stable enough to stop all drug treatments. If you are allowed to stop all medications, you have to find out how to manage the symptoms of arthritis during times of flare-ups.
Otherwise, if stopping medications is adverse to your condition, then the doctor may probably prescribed lower doses and safer drugs such as azathioprine, corticosteroids (dexamethasone or betamethasone), intravenous immunoglobulin, sulfasalazine, cyclosporine or others. Typically, your doctor will monitor any effects of the prescribed medications on your pregnancy.
For the safety of you and your unborn baby, stop any over-the-counter (OTC) medications and if you are taking other forms of vitamins or supplements, please get advice from your doctor. Besides medications, you must also consult your doctor if you are physical-ready to withstand the additional body weight that come with pregnancy. This is especially important if you have arthritis in the joints of the knees, hips, ankles or feet. To find out, you will have to do a self-test and assess your ability to take care of the baby.
With the guidance of your doctor, you can use a 10-pound bag of potatoes to test on your physical readiness and stamina by lifting up, walking up and down the stairs or hugging it for a period of time. Then, mimic through the motions of feeding milk, changing diapers, bathing or dressing the baby and other baby-care tasks. While doing the test, take note of any discomfort or difficulties you may encounter. At the same time, ask yourself if anyone will be helping you during baby care or you required certain adaptive equipment perform the tasks. The main point is to anticipate any problems and prepare physically as well as mentally ahead of pregnancy.
How Will Arthritis Affect My Chances Of Conception?
Generally, having arthritis does not mean it relinquishes the chances of getting pregnant but rather it takes a longer time. This could due to several factors like low sex drive, feelings of restlessness or depression, fatigue, irregular ovulation, chronic pain or medications. Many studies indicate that low sperm production, erectile dysfunction and decreased testosterone levels in men occurs when arthritis is active. As for women, their inconsistent ovulation and emotional swing (depression, sadness or stress) due to chronic joint pain affected their desire to get intimate. Therefore, planning for pregnancy with arthritis is recommended to start during period of remission.
How Will Arthritis Affect My Pregnancy?
During pregnancy, a hormone known as relaxin is produced that stretches the muscles, ligaments (connective tissues between 2 bones) and cartilage (rubbery tissue that protects the ends of the bones). As such, this results in laxity of the connective tissues which causes loose and weaker joints. This could lead to further damages or injuries to the joints which are already affected by arthritis.
Due to the growing baby, it increases your overall body weight and places additional strain on your knees, hips or feet. Especially for those who have osteoarthritis, this causes intense joint pain when you move around. Besides, your spine will also naturally bend to support the weight of the fetus which causes back pain or numbness in the legs.
Apart from this, the increased amount of water in the body adds on the stress of your weight-bearing joints and increased joint stiffness. Starting from the 2nd trimester, you may also experience foot pain when the excess fluids accumulated at your feet (Edema). Water retention can also occur at the hands which causes complications for those who have carpal tunnel syndrome.
Both pericarditis and myocarditis is a form of heart disorders which is caused by rheumatoid arthritis or lupus. These heart problems add on to the strain of the heart and causes complications due to an increased rate of blood circulation. Therefore, it is not advisable to get pregnant if you have pericarditis or myocarditis. In the case of rheumatoid arthritis, respiratory or breathing becomes a problem too since it affects the heart muscles and blood vessels.
How Will Arthritis Affect My Baby?
Another major concern in the planning for pregnancy with arthritis is whether or not the baby will inherit the disease. In fact, the answer is probably “YES” or “NO”. Why? Though many studies have concluded the association of particular genetic markers with different types of arthritis, there is no strong evidence to support this claim.
This is because other than heredity, there are several affecting factors to the development of arthritis. If you have concerns that you may pass the disease to your baby, you can consult a genetic counsellor who is able to assess your baby’s risk for birth complications with regards to genetic aspects of arthritis.
Out of the common types of arthritis, perhaps ankylosing spondylitis (AS) is the only condition that can pass from mother to baby especially if your blood cell type is HLA-B27 with the probability risk of 16.6%. For psoriatic arthritis, though the risk of inheriting the disease is very slim (1% to 3%), the chance of having psoriasis (skin disease) in the baby is higher.
As for those women with rheumatoid arthritis, the chance of passing down to the baby is very low which is between 1% to 3%. But the chance of having premature births, newborn complications and miscarriage is higher due to RA medications. Therefore, if you are on medications like NSAIDs (non-steroidal anti-inflammatory drugs), aspirin and especially methotrexate or leflunomide, you doctor will advise you to stop before and during pregnancy.
This applies to the father as well (Drugs like sulfasalazine and cyclophosphamide reduces sperm count in man. Leflunomide and methotrexate can have a negative impact on the unborn baby). That is why if you and your spouse have intended to start a family, it is essential to consult your doctor to avoid the risks of birth defects or other pregnancy complications. An interesting fact is that if you are suffering from RA, the symptoms actually improve during pregnancy with minimal joint swelling, pain and stiffness.
As for osteoarthritis, it is usually caused by prominent factors like joint injuries or trauma, repetitive use of the joint, overweight and old age. As such, it usually does not affect your baby at all. However, for nodal osteoarthritis, heredity plays a major factor that has high chances of passing down to the next generations. However, as it generally develops in women in their 40s to 50s (which is during menopause stage), the chances of developing nodal OA is very slim during the pregnancy stage.
For those who have systemic lupus erythematosus (SLE), the symptoms may remain the same, improves or worsen during pregnancy. Besides, it also results in an increased risk of premature births whereby the baby is underweight or suffered from congenital heart block or neo-natal lupus. As such, pregnancy with lupus should be planned during periods of remission and under close supervision to avoid all these pregnancy risks. However, for others who had severe lupus, then pregnancy is too risky for you as it can results in heavy strain on your lungs, heart and kidney.
Will Arthritis Affect My Delivery?
Though there are no complications that will affect the delivery, you will experience pain particularly at the joints of the hips and back. If the traditional way of vaginal birth by lying on the back is not comfortable for you, check with your doctor on the options of various positions which can be adopted during delivery. Alternatively, you can opt for cesarean section. If you are afraid of the pain, opt for epidural which can relieve pain effectively. However, for those who have ankylosing spondylitis (AS), having an epidural may not be suitable.
How Will Arthritis Affect Me After My Birth?
This is where you will feel extreme fatigue and experience emotional roller-coaster. Coping with newborn baby is a very exhausting task and things can get out of hand especially when the symptoms of arthritis flare up. Therefore, while you are planning for pregnancy with arthritis, make sure you take into considerations of who are your helpers (family members, relatives or friends) during this period. Getting a nanny to help you in taking care of the baby is one of the great options which you can consider. This is especially true if you already have other children who still required taking care of.
After your birth, your doctor will most probably ask you to resume your course of medications for arthritis. However, if you are breast-feeding, any medications that you take may pass to your baby. As such, check with your doctor whether the medications will affect your baby. Some of the drugs like ciclosporin, gold injections, leflunomide or methotrexate should be avoided if you are breast-feeding.
On the other hand, drugs like ibuprogen, diclofenac, sulfasalazine , hydroxychloroquine and azathioprine are known to be safe for breast-feedings as long as it is taken in smaller doses. Still, you have to consult your doctor and do not take any other over-the-counter prescriptions, vitamins or supplements.
With proper planning for pregnancy with arthritis, it helps to prevent unnecessary complications that may arise before, during and after pregnancy. If you are determined to be a mother and looking forward for a young, beautiful life in your family, you and your spouse must work closely by having an open discussion with your doctor. Highlight all your concerns and worries which are bothering you. Do not conceal any facts that might hinder you from having a healthy and chubby baby.
Having arthritis does not mean you cannot enjoy the happiness and blessing of being a mother. In fact, many women with arthritis have a normal course of pregnancy and you can be one of them as long as you maintained an active lifestyle, watch your diet, exercise regularly and adhere to your arthritis treatment in controlling the disease.
However, if your condition does not allow you to get pregnant, do not feel shame or depressed and give up on family planning. Arthritis is just a small milestone part of your life which introduces new challenges. Adoption is a personal option and decision that you may consider to fulfill your new hopes in life.