If you have RA and decide you want to start a family, you probably won’t have any more trouble getting pregnant than other women. As many as one in five couples have difficulty conceiving, regardless of any known medical condition. Although some studies show that women with RA have fewer children than otherwise healthy women, that may represent a choice to limit family size rather than a reduced ability to conceive or carry a baby to term. A 2006 study by researchers at the University of California, San Francisco, found that women with diagnosed with RA before the birth of their first child had the fewest pregnancies and children.

Before you try to conceive, it’s important that you speak with your doctor about the medications you're taking.  Some can affect an unborn child from the very earliest days of pregnancy and because the effects of certain drugs can remain in the body for a period of time after you stop taking them, ideally, you should work with your doctor to taper off harmful medications – and perhaps switch to less risky medications – for at least a few months before you try conceive.

Before you get pregnant is also the best time to speak to your doctor about prenatal vitamins and supplements of folic acid, which can help reduce the risk of certain birth defects. Your doctor may also recommend a calcium and vitamin D supplement, but will probably advise that you avoid any over-the-counter herbal remedies.

First Trimester

If you unexpectedly find yourself pregnant and haven’t spoken with your doctor about medications – now is the time. Some drugs, such as leflunomide (Arava), methotrexate and cyclophosphamide (Cytoxan) can cause birth defects can cause birth defects. If you’re taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, your doctor may let you continue to using them – at least for a while. The greatest risk of these drugs comes later in pregnancy, when they may interfere with labor, affect amniotic fluid production or cause excessive bleeding during delivery. If you need medications to keep your disease under control, your doctor may put you on a corticosteroid, such as prednisone, that reduces arthritis inflammation but crosses through the placenta only minimally.

One of the first symptoms of pregnancy for any woman is fatigue. For women who already experience fatigue with rheumatoid arthritis, fatigue may worsen. Otherwise, pregnancy should have little effect on arthritis during this trimester; nor should arthritis have any effect on pregnancy. If you have relatively mild disease during the first trimester, there’s good news: Your disease is likely to remain mild through pregnancy, according to a 2008 study conducted by researchers in the Netherlands and reported in Arthritis & Rheumatism. If your disease is active during the first trimester, there’s a good chance it will improve a little later in your pregnancy.

Second Trimester

Approximately 70 percent of women with RA experience an improvement in symptoms beginning in the second trimester and lasting through about the first six weeks after delivery, says J. Bruce Smith, MD, assistant compliance officer for research at Thomas Jefferson University in Philadelphia and a rheumatologist whose research has focused largely on autoimmune disease and pregnancy. Fatigue may improve as well.

There are a number of theories why disease symptoms improve, including increased levels of anti-inflammatory cytokines and hormonal changes that occur during pregnancy. Researchers are continuing to study the phenomenon.

Exactly why some women with improve while others don’t is unknown, but a new study out of the Netherlands shows that women who are negative for rheumatoid factor and a type of autoantibody called anti-CCP are more likely to improve during pregnancy. Research also suggests that the father’s genetic contribution may play a role. The more genetically dissimilar a baby is to its mother, the better – at least as far as the mother’s disease goes.