Rheumatoid arthritis RA is more common in females and often presents at an age when people are considering starting families. The management of RA before, during and after pregnancy, is an important topic. Managing rheumatoid arthritis in pregnancy has the potential to be complex for several reasons:. It is important to remember that while RA has the potential to affect your pregnancy, pregnancy itself also has the potential to affect your RA.
This guide aims to cover some common concerns that women with RA may have about their pregnancy journey. However, if RA disease activity is well controlled, there is no particular reason why most women with RA will not be able to fall pregnant and enjoy a successful pregnancy.
As with any normal pregnancy, planning ahead is important, and you should discuss your plans as early as possible with your rheumatologist. Following a healthy lifestyle will increase your chances of conceiving and reduce potential problems during pregnancy. The risk of adverse pregnancy outcomes, such as miscarriage, for women with RA is not significantly greater than for any other pregnant women as long as the RA is well controlled.
All women who are pregnant or planning a baby should take folic acid supplements 0. Some medications used to treat RA can be continued while trying to conceive although there are a few such as higher dose prednisolone that have the potential to reduce fertility. There are also some medications that may have to be stopped for a while before trying to conceive to ensure they are eliminated from the body. Some women find that the pain and swelling associated with RA improves throughout pregnancy.
It is therefore important to ensure that there is a clear plan of action in place in case your symptoms do get worse. During the later stages of pregnancy, swelling, backaches, and tiredness are common regardless of whether someone has RA or not. It is therefore difficult to guarantee that drugs are safe for use in pregnancy, especially with newer drugs, where the number of pregnancies studied is still low.
In addition to this, animal studies that may have been carried out are often not applicable to humans. Although you may be concerned about the possible harmful effects of taking anti-rheumatic drugs whilst pregnant, it is important to remember that uncontrolled RA during pregnancy can potentially lead to adverse pregnancy events such as low birth weight. Some of the concerns about the use of common drugs used to treat RA during pregnancy are listed below.
High dose NSAIDs have been associated with reduced fertility in women, so this should be considered when planning a pregnancy. NSAIDs are considered safe to take in the first and second trimesters of pregnancy although we recommend their use in the lowest dose possible. NSAIDs are safe to take while breastfeeding and many women find them beneficial to treat pain after childbirth i. There is no good quality data about their safety during conception, pregnancy or breastfeeding.
Therefore, it is advised that both men and women avoid these medications while trying to conceive, and women continue to avoid during pregnancy and whilst breastfeeding. Low to moderate doses of corticosteroids can be safely used during conception, pregnancy and breastfeeding.
Corticosteroids should be used in the lowest dose possible to control the disease, as higher doses have been linked to adverse pregnancy outcomes such as premature rupture of membranes as well as an increased risk of hypertension and gestational diabetes.
Hydroxychloroquine is safe to continue throughout pregnancy and is compatible with breastfeeding. It is also not thought to affect fertility. These side effects usually happen during the first three months of treatment and often clear up if the dose is lowered.
Sulfasalazine may make you more likely to develop infections and allergies. You should tell your doctor or rheumatology team straight away if you develop any of the following after starting sulfasalazine:. Sulfasalazine may cause your urine to change colour, to orange, but this is nothing to worry about. It may also stain soft contact lenses and tears yellow. Your doctor will arrange for you to have a blood test before you start treatment.
You may be asked to keep a record of your blood test results in a booklet, which you should take with you when you visit your GP or hospital. You can carry on taking non-steroidal anti-inflammatory drugs NSAIDs or painkillers if needed, unless your doctor says otherwise.
It's usually fine for people on sulfasalazine to have vaccinations, but check with your GP and rheumatology team to make sure a vaccine is safe. Pneumococcal new-mow-cock-all vaccine, which protects against the most common cause of pneumonia new-mow-nee-uh , and yearly flu vaccines are safe and recommended.
This limit is 14 units a week for women and men. You can find out more about units of alcohol at www. Guidelines state that it's safe for women to continue using sulfasalazine when trying for a baby and during pregnancy.
It's often recommended that you continue sulfasalazine throughout pregnancy to prevent flare-ups. This is because sulfasalazine can reduce levels of folic acid in the body. Talk to your doctor as soon as possible if you are planning a family, or if you become pregnant while taking sulfasalazine.
Because sulfasalazine can potentially affect folic acid levels, women taking it while trying to conceive and during pregnancy should be prescribed a high dose folic acid supplement. Ideally, women planning a pregnancy should speak to their specialist to determine whether sulfasalazine is still the most appropriate medicine for them. If you have an unplanned pregnancy while taking it, you should be reviewed at the earliest opportunity by your specialist.
For many, ongoing use of sulfasalazine in pregnancy will be considered appropriate. Left untreated these can be serious and can also lead to pregnancy complications. Your doctor will only prescribe medicines when absolutely necessary and will be happy to talk to you about any concerns that you might have.
All pregnant women in the UK should be offered a detailed anomaly scan at around 20 weeks of pregnancy as part of their routine antenatal care.
No extra monitoring for major birth defects is required following sulfasalazine use in pregnancy. If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www. You will be asked to enter information about your health, whether or not you take any medicines, and your pregnancy outcome.
You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies.
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