In a nutshell
This article analyzed the most up-to-date research with regards to pregnancy and rheumatoid arthritis. The research included patients before, during and after pregnancy.
Some background
Very early medical researchers (1930) noticed that women who had rheumatoid arthritis had some relief from their symptoms during pregnancy. Although this is good news for patients, it is important to be aware of any potential risks before and after pregnancy so that these can be addressed.
Methods & findings
This study analyzed and summarized results from articles published on pregnancy and rheumatoid arthritis. They report findings in 3 key areas: issues arising before pregnancy, during pregnancy and after pregnancy.
Before pregnancy
Rheumatoid arthritis can prolong the time it takes to get pregnant. In a study of 112 patients, more women with rheumatoid arthritis (25%) took longer than 12 months to conceive than women without rheumatoid arthritis (12%). It was suggested that higher disease activity before pregnancy may have contributed to the longer time. It was further suggested that a change in prescriptions due to family planning may have provoked this higher disease activity.
During pregnancy
Although there is some improvement to the mother’s symptoms during pregnancy there may be some additional pregnancy risks. There seems to be worse pregnancy outcomes for women with rheumatoid arthritis. They had more frequent vaginal bleeding, elective C-sections (delivery of the baby through an incision in the abdomen and uterus), preterm deliveries (birth before 37 weeks of pregnancy) and had babies with lower birth weight.
Low disease activity in the first trimester (first three months of pregnancy) is linked to lower disease activity in the third trimester (final three months of pregnancy). For this reason it is advisable to aim to maintain low disease activity when trying to get pregnant.
After pregnancy
For mothers who choose to breast feed the drug treatment options available are more limited. To reduce symptoms breastfeeding mothers should minimize overuse of affected joints during this time. Breastfeeding may also affect disease activity after pregnancy. One study showed that first-time-breast-feeders had increased disease activity.
The bottom line
The authors conclude that rheumatoid arthritis may spontaneously improve during pregnancy. However to minimize risks during pregnancy the aim should be to reach low disease activity before pregnancy.
What’s next?
If you are trying to conceive it may be helpful to discuss reproductive health or counselling options with your doctor.
Published By :
Current Opinion in Rheumatology
Date :
May 01, 2014
