Having well-controlled RA at the time of conception is the key to keeping it under control while you’re pregnant
You’re pregnant, and you’re thrilled (congrats, by the way!) … but you’re worried, too. What does this mean for your rheumatoid arthritis (RA)?
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Good news: Healthy, successful pregnancies can absolutely be in the cards for people with RA.
“It’s all about receiving good preconception counseling and working with your doctor to closely manage and control your RA,” says rheumatologist Emily Littlejohn, DO, MPH. “Having good disease control with pregnancy-safe medications is really going portend the best prognosis and the healthiest delivery for you and baby.”
She delves deeper into what you need to know about being pregnant and having rheumatoid arthritis, including how you can best manage your condition before, during and after your pregnancy.
For a long time, doctors believed that most people with rheumatoid arthritis would have inactive disease during pregnancy with a tendency to flare up after giving birth (postpartum). But that’s not necessarily the case anymore.
“It used to be accepted that the expectation was most people would have quiet disease during pregnancy with a high chance of flare postpartum,” Dr. Littlejohn says, “but now we have more data to show that if you go into pregnancy with well-controlled RA, you will likely come out of the pregnancy with well-controlled RA.”
Dr. Littlejohn explains how, with the help of your healthcare professionals, you can get your RA under control and plan for a healthy pregnancy.
The term “disease control” refers to managing your rheumatoid arthritis, usually with medications. When your RA is well-controlled, you shouldn’t experience daily pain or other complications typically associated with RA.
“Disease control equals less pain. If you’re really well-controlled on a regimen, you’re going to have minimal pain, swelling and stiffness,” Dr. Littlejohn says. “If your RA is uncontrolled, though, you’re likely going to experience more of those symptoms.”
That may be especially true in pregnancy, which places a new burden on your joints and changes the way bodies manage inflammation — which is why it’s so important to try to get your RA under control before you conceive.
As with so many other aspects of your health, open and honest communication with your doctor is key. And when you have rheumatoid arthritis, it’s important to start communicating early. Even if you don’t want to start trying to get pregnant for years, it’s worth bringing up with your rheumatologist now.
“When a patient of child-bearing age is diagnosed with rheumatoid arthritis, I like to talk to them about their pregnancy plans right away to learn whether they want to have a family,” Dr. Littlejohn says. “Then, if they do want to have kids, I want to discuss the timeframe.”
Knowing your timeframe for starting a family can help your doctor figure out your course of treatment, including what medications to prescribe and how they might need to change your treatment down the road.
The right medicine is critical to controlling your RA. And if you’re planning to start a family, it’s extra important that you’re on a medication that’s been deemed safe for pregnancy.
The key to getting your RA under control is often tumor necrosis factor (TNF) inhibitors, medications that help stop inflammation — and importantly, they’re now considered safe during pregnancy and breastfeeding. This includes:
“These medications have changed the game for people with rheumatoid arthritis who want to conceive,” Dr. Littlejohn says. “You can use them safely throughout your pregnancy.”
If you’re taking an RA medication that isn’t safe for pregnancy, your rheumatologist will want to switch you to something else — and that can take a little bit of time.
“We like to give people at least three months, but sometimes six months or longer, just to make sure their RA is very well-controlled before they get pregnant,” Dr. Littlejohn states.
“TNF inhibitors pose minimal risk to the fetus,” Dr. Littlejohn confirms. “The only caveat is that when your baby is born, there might be some changes to their vaccine schedule.” Doctors recommend that newborns who were exposed to TNF inhibitors in the uterus shouldn’t receive live vaccines until they’re at least 6 months old.
Live-attenuated vaccines (commonly just called live vaccines) include a weakened form of the virus they protect against. They include those to protect your child against:
Before you get pregnant, your doctor will want to make sure you’re on the lowest dose possible of corticosteroids — or not taking any at all. These anti-inflammatory medications can help relieve the symptoms of RA flares.
“If your RA is really uncontrolled, you’re likely to need high doses of steroids, which we use when people are flaring,” Dr. Littlejohn explains, “but being pregnant while taking these medications can pose a risk to both mom and baby.”
Prednisone is one of the most commonly prescribed corticosteroids for RA. Up to 20 milligrams of prednisone is considered safe for pregnancy, but any more than that can cross the placenta and affect your baby. This can cause:
It might come as a surprise to learn that rheumatoid arthritis can get better, not worse, during pregnancy. This is common feedback from people who have RA and are pregnant. But why would this be the case?
“During pregnancy, the body goes into a quiescent state, which is when the disease becomes inactive or quiet,” Dr. Littlejohn explains. “We think that the body does that in an effort to preserve and foster the pregnancy.”
Again, though: If your RA is well-controlled when you enter pregnancy, you should already be feeling pretty good — which means your RA is already fairly quiet.
Do we sound like a broken record yet? If you have well-controlled RA, it’s likely to remain well-controlled after you’ve given birth. But this wasn’t always thought to be the case.
“We used to be very worried about a postpartum flare because that’s when the body’s immune system wakes back up,” Dr. Littlejohn says. “Now, though, we know that if patients go into the pregnancy well-controlled, they’re also likely to come out of it well-controlled.”
Still, it’s important to keep up with your RA treatment once your baby has arrived, which will help prevent or treat any possible flare-ups. She recommends seeing your rheumatologist within 90 days of delivery so they can assess your RA status and decide if you need any changes in treatment.
Statistics show that about 50% of patients develop RA during their reproductive years. But that doesn’t mean that being pregnant is a risk factor for developing RA.
“The state of pregnancy itself does not put you at risk for developing rheumatoid arthritis,” Dr. Littlejohn reassures.
If you don’t have RA but are experiencing significant joint pain during pregnancy, it can likely be attributed to the many bodily changes that come with being pregnant.
“There can be a lot of normal aches and pains that come with pregnancy,” Dr. Littlejohn says. “When you’re pregnant, your ligaments relax more than normal, something called ligamentous laxity. This can affect your joints and cause joint, hip or low back pain.”
The reverse is true too: Even if you have well-controlled RA, you may still experience some of the common aches and pains associated with pregnancy. While that certainly isn’t comfortable or desirable, it also doesn’t necessarily mean you’re having an RA-related flare.
If you or your partner have RA, it’s possible that your child will develop it, too — but it’s not a given. Many parents with autoimmune diseases give birth to healthy babies who don’t develop RA or other autoimmune diseases.
“Rheumatoid arthritis can run in families, and there is a genetic predisposition for this disease,” Dr. Littlejohn says. “But it’s not a direct inheritance.”
Once you’re pregnant, it’s important to tell your rheumatologist that you’re expecting and to let your Ob/Gyn know that you have RA. This way, they can work in tandem to make sure you’re getting appropriate treatment for both.
“They’ll work together to strive for low levels of disease activity before and throughout your pregnancy,” Dr. Littlejohn says.
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