Can women with rheumatoid arthritis have normal pregnancies? — Yes. It is possible for women 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 pregnant women), 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 yearsbefore trying to get pregnant. Or your doctor can give you another medicine to make the leflunomide leave your body faster. Then he or she 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 or leflunomide, tell your doctors right away. Your doctors will help you decide whether to stop (or switch) any other medicines you are taking. Plus, they might suggest added treatment.
How will my rheumatoid arthritis affect my pregnancy and my baby? — RA does not usually cause problems with pregnancy or the baby’s health. But some women with RA might not get pregnant as quickly as other women. 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.
- Methotrexatecan cause miscarriage (when the pregnancy ends before 20 weeks). It can also cause the baby to not develop correctly.
- Leflunomidecan cause the baby to not develop correctly.
- High doses of steroids in early pregnancy can increase the risk of a birth defect 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 in 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 women with RA to help keep the disease under control. (These are notthe 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 rheumatoid arthritis symptoms? — It might. Many women with RA notice that their symptoms get better during pregnancy. But some women’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
- Trouble breathing
- 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. Women with RA can safely breastfeed. But they have to avoid certain medicines while they do. 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 women need to stop breastfeeding if they need these medicines to control their RA.