Rheumatoid Arthritis

Pregnancy & breastfeeding with rheumatoid arthritis

It is important for both women and men with rheumatoid arthritis to talk to their rheumatologist or GP when planning a pregnancy as the strong drugs can affect the ability to conceive and affect the baby, even when taken before conception. Not all drugs taken for RA harm the foetus so continuation of some may ensure the health of the mother as well as the baby. Many women find their RA symptoms subside during pregnancy, enabling them to use less medication. Giving birth should be no more difficult, but looking after a baby or children is tiring and additional support may be needed.

Ten of the women we interviewed with RA had had one or more children since being diagnosed. Two had chosen not to take any Disease Modifying Anti-Rheumatic Drug (DMARD) until after having their child. One took no medication during pregnancy and others were advised on what they could safely continue. One woman conceived whilst taking penicillamine, so quickly consulted her gynaecologist about any risks. She continued to use NSAIDs and painkillers during her pregnancy.

The consultant discussed with one woman and her husband the DMARD medication options available, knowing they still wanted to add to their family. She chose a DMARD but knew she would need to stop taking it before trying to conceive a second child.

One 29 year old woman and her partner expressed their worries at her having to stop existing medication for several months before conceiving. Both worried how she would cope with the symptoms of the RA during this period,. For another 43 year old this was one of the main reasons she had decided against having children. Other women, not currently in a relationship, also worried about the effects of the current medication on their fertility and one felt having RA for many years had affected her confidence with men and meant she had not found a partner to have a family with.

For many of the ten women the RA symptoms subsided during pregnancy and they felt very well. One woman said that unfortunately she was unlucky because her symptoms didn't improve that much and had to manage pain without medication. Another said that although the swelling in her joints remained the pain went during both her pregnancies. One woman had relief during the first pregnancy but not the second when her joints got worse. Commonly women's symptoms returned within weeks or months after the birth and were often more severe or widespread than before conception for a short time, but then returned to pre-pregnancy levels.

Painful swollen joints developed just days after the birth of one woman's second child and this was diagnosed as RA. One 27 year old who had had joint problems for 4 years found her wrist pain and mobility improved during pregnancy and then returned some months after the birth of her daughter. Seven weeks after the birth of her first child one woman woke up with a stiff neck and the following day, couldn't really move or walk. She was later diagnosed with having RA.

Only two women talked about the actual birth. Both had considered having caesarean births but one had a vaginal delivery.

Antenatal Care

During pregnancy and apart from their rheumatology team women with rheumatoid arthritis received medical care and advice from an obstetric team which includes a consultant, midwife and other health staff from their local maternity hospital. One woman thought very highly of her antenatal care and the support she got from the obstetric consultant and midwife. She felt reassured by her frequent checking up appointments, their willingness to listen to her concerns and apprehensions and the liaison between her antenatal and rheumatology teams. (See also 'Biologic treatments')

Breastfeeding

Breastfeeding can also affect the medications that a new mother can take and you should ask your rheumatologist team for advice. One woman describes how she could take some medication for a few months whilst breastfeeding her two children before stopping to take stronger medication. Another indicated that she was determined not to let RA interfere in her ability to provide her daughters with the 'best start in life' and delayed for as long as she could methotrexate. Four women found the DMARD that had successfully controlled their symptoms before pregnancy was no longer effective afterwards and they changed to a different type.

Last reviewed August 2016.

Last updated September 2010.

 

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