Third Trimester

If your disease was mild to start with or improved during the second trimester, it will likely stay mild through the third trimester. However, fatigue may become worse as you grow heavier and closer to delivery.

Labor and Delivery

Having rheumatoid arthritis may slightly increase your risk of a premature baby, but does not increase your risk of having a baby with low birth weight, according to a 2006 study by researchers at the University of Washington, Seattle.

Women with RA are also more likely to have their babies delivered by Cesarean section. “Any form of arthritis that involves the hips may make vaginal delivery difficult,” says Michael Lockshin, MD, professor of medicine and Ob/Gyn at Weill Cornell Medical College and director of the Barbara Volcker Center for Women and Rheumatic Disease at the Hospital for Special Surgery in New York “The biggest problem is that you have to be able to spread your legs fairly wide. A baby is a pretty big package to get through there.” For that reason, women with arthritis – even if their disease is inactive and their pregnancy uncomplicated – may be more likely to deliver by C-section.

If you took corticosteroids for more than two or three weeks during pregnancy, your doctor will likely give you stress doses of corticosteroids during delivery and monitor your baby after delivery to make sure she is producing adequate corticosteroids on her own.

Infection is a possibility after any delivery. If you are taking medications that suppress your immune system, however, infection is more likely. Most infections can be cleared up fairly easily and quickly with available antibiotics.

Postpartum

If you’ve enjoyed milder disease during your pregnancy, there’s a fair chance your disease will worsen again – at least for a while – after you deliver.

In a 2008 study out of the Netherlands, 39 percent of RA patients studied had at least one moderate flare postpartum.

While all new mothers need help from family or friends, you may especially welcome their help as a new mother with RA. You may find yourself having to deal with a disease flare at the same time you are trying to recuperate from childbirth and adjust to parenthood.

After you deliver, it is important to discuss medication choices with your doctor again, particularly if you plan to breast feed. Certain medications – including methotrexate and leflunomide – should not be taken during breastfeeding because of their potential effects on the baby. Others – including prednisone, certain NSAIDs and hydroxychloroquine – are probably safe and may be prescribed on a case-by-case basis.