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 (See “Arthritis Medications in Pregnancy: What’s Safe, What’s Not.”) – 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.
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) and methotrexate can cause birth defects. If you’re taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or ketoprofen, 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 predisone, 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.
Thanks ladies for all your information, it helps a lot and makes me more aware of what is going on. In some of the stoires I am jsut thinking that we are all different and how sorry i am that you went through what you did, I hope it is different for me.
Dear all, am physiotherapist n working with rheumatologist. DMARD (disease modifying anti rheumatic drug) is a drug of choice in RA..plz check it out. I just found it on google. DMARD has less side effect than NSAIDS. Many of my patients are taking it ..and it really works if given in early stage of ra.. Wish u al good health.
I have a positive ANTI CCP and RF. The xrays do not show anything but I have been having joint pains for a year now. All the inflammatory markers are normal.
I am 23 and my boyfriend just proposed 2 weeks ago. He also has knee issues all the time. My hips hurts a lot and my elbows are always stiff.. I would get spasms from my back buttocks area when i am walking and it hurts so bad.
Honestly, I know that God will not put a burden on me that I cannot bear.. but I am beginning to think I cannot handle this. We both want kids and we love each other very much. But I dont want him to be stuck with me. I feel so depressed and I cannot concentrate on work or soon.
since my rheuma. says the xrays are fine but the AnTI CCP is high, i am on some anti inflammatory drugs to help with the hip pain. I am thinking about starting some strong medication because I dont want there to be further joint damage.
To those that have managed to find fulfilling lived with RA, I admire you. Right now, I am a hot mess, crying all the time, praying and worrying. Please pray for me because I do not know if i can handle it.
There is definitely a genetic component. For now all I can do is hope for the best and cross my fingers.
I wish all of you the best too.
I no i turn this into a long story but since the age of 16 thru current age 52 this was the one and only time for a whole 9 mo plus approx 4 to 5 weeks after my baby was delivered that i didn't have any pain, signs or symptoms of my RA, just pain from the C-sec. and then all the RA creeps back full blast and the pain felt 10 times worse. I was almost bedbound for the next 2 mo. There was only a few new meds that had came out at this time and none helped me except the predinsone injections & parrafine/mineral oil baths for my hands every morning. I have particapated in many of the drug studies for the meds and treatments that i see listed on this page. Only one did i get the real stuff (Remicaid) and not the Placebo . I couldnt wait until it was FDA approved. I was on the Remicaid infusion for 9 years and been on methatraxate for 20 years. I have topped out on all available meds and treatments now and been discharged by my Rhuematologist stateing there is nothing he can do for me that my MD can't manage. GOOD LUCK TO ALL! Still not in wheel chair yet but have had several surgeries and have both hands with surgically knuckle implants with Rt wrist & thumb fusions.
Good luck to all. You're not the only ones in incredible pain! I also worry about after giving birth with caring for the baby with flares and if I will be able to nurse.
I have not taking the med for 3 to 4 week now, well I took one on 9/5 bc I was in so much pain and thinking I can’t be pregnant. I thought once your pregnant your RA subside for the next 9 month.
You're not alone. I am 13 weeks pregnant and so far my RA has not gone into remission either. I am in constant pain everyday. I can barely lift anything because my wrist are so sensitive and some days can barely walk because my knees and ankles hurt so bad. I am finding it harder and harder to go to work everyday.
I was diagnosed with RA at 22 and am now 26. In planning for a pregnancy I was told to come off Methotrexate and once pregnant stop taking Hydroxychloroquine. But was just told a week ago to taper off prednisode. So far I am having a horible experience with this. I am TRYING to remain optimistic that I will start to feel better soon.
I just want a healthy baby so I would rather feel like this for another 6 months then to take any RA meds. I don't want this experience to keep me from having more kids in the future but I know I will not be in any rush if I continue to feel like this! Just being honest!
I did not go into remission. I've had shots in my hips and am on prednisone. I take extra strength Tylenol every day but I can't take too much. Basically all I'm told is that I have to deal with this until the baby comes. I'm sucking it up but I am having a hard time getting around the house and sleeping is very hard for me.
This article and the comments make me feel like my experience is not the norm.
I've read this article and all your comments and I'd just like to thank everyone for sharing their wealth of experience and knowledge.
I'm 32 and I've had psoriatic arthritis for 20 years. I find myself at a crossroads at present re the prospect of pregnancy. Some assume that because of my condition I shouldn't or couldn't attempt to conceive and raise a child, but it isn't as simple as that.
I still don't know which way to turn, but at least I have more information now than before.
I wish the best for us all,
Fliss :)
- One gene alone does not cause RA and the direct cause is still not known. While particular genetic markers that predispose have been identified, a trigger (genetic mutations or environmental factors) is also thought to be needed for the occurrence of the disease.
- There is a genetic link that IS inherited, providing a much greater predisposition of inheriting the disease if a family member has the gene. (A 2004 study states: "The heritability of rheumatoid arthritis is 60%, reflecting a strong genetic component in the disease.")
- In a 1953 study of 224 Families, there was a total population of 1,667. 15.8% of that population was affected by RA. The data, versus the control population yielded this result: "Thus, it is seen that rheumatoid arthritis affected all relatives of patients with rheumatoid arthritis 5 times as frequently 3.1 per cent to 0.58 per cent) as it did the [control] population in general..."
- While the above is a 'dated' study, it further proves that a family history of RA makes it more likely that: If you have RA, your child is more likely than the average population to receive an RA diagnosis as well.
- Assessing how RA is inherited is challenging because the disease is expressed variably in different people.
- We do know that children who inherit the HLA-B27 protein are at increased risk of Pauciarticular JRA.
- There is a higher preponderance of RA in women: 70% of people with RA are women.
- An estimated 1.3 million people in the US have RA, which is nearly 1% of the population.
- Over 300,000 children are diagnosed with JRA.
All I can say on a personal level... and I'm sure everyone will have a different testament...
Although I've been through very emotionally and physically painful times in my 28 year battle with JRA, I've never wished that I had not been born. I've always loved my life and felt the disease made me a stronger person in many other was. We learn to compensate with ailments, and I personally have learned how to live a very fulfilled life.
If I am ever able to have a child (my struggle to conceive continues)... the probability is that my baby will inherit the disease.
But, at least I'll know better what to do and how to help him/her cope. I hope they'll never have a day that they wished they were never born. I will do my best to raise my child in the proactive way that I was raised. There are hundreds and thousands of parents around the world who discover their child has JRA or RA, who are terrified and don't have a clue as to what's to come. I'm thankful for being prepared - armed with experience and knowledge.
There is an entire clinic in California dedicated to Immunology reproductive medicine for a reason. 1 in 200 couples will experience two or more consecutive miscarriages. Included within the Top 5 reasons... Immune Mechanisms at 50%.
I've had JRA for 27 years. All of my bloodwork is coming back 'normal' except for one factor - IgA deficiency - associated with autoimmune states. My husband checked out too, so his sperm are not our issue.
I went off Rituxan two years ago to try and get pregnant. At the urging of my husband, a specialized Cardiologist, I went to a Reproductive Endocrinologist.
Failed 3 IUI's and 1 IVF cycle. I've had 3 miscarriages within the first trimester - all chromosomally normal girls.
I've had to go back on Rituxan infusions because my arthritis has flared so badly. Being a Class C Drug, I'm forced into a 1 year wait before trying again.
It's been a painful process mentally and physically. Perhaps the reason I am struggling with Recurrent Loss is not associated with the Autoimmune factor - we may never know. However, please do not MISLEAD women with JRA/RA who are struggling to get pregnant with false hope or misinformation.
I know others besides myself who have an autoimmune disease and infertility issues as well. I also have the medical studies, statistics, and several RE's to backup my statement.
You said it yourself, "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." Perhaps this is not driven by CHOICE, as you recommend, but rather because JRA/RA CAN CAUSE problems with fertility.
I've been very involved with the Arthritis Foundation for many years, and this article makes me want to throw in the towel. It is of no right that this organization give false information or provide assumptions on issues such as this. Omit your first paragraph, and it's actually a good article. I realize the intensions of the article were in good faith, but please stick to the facts.
At that time I could not continue to work- I could not even get shoes on!!! I wore an old pair of my Great Aunt's orthopedic sandals. Thank God it was summer and I liked to swim. It was the only exercise I was able to do.
I prayed a lot. I was put on 20 aspirin a day and all it did was make my ears ring. The R.A.doctor switched me to Naprosyn and recommended that I be put into a skilled nursing facility for a three week program called "Living with Arthritis". In the morning my hands were so swollen that I would have to exercise them before I could even pick up anything.
After about two weeks on Naprosyn, the swelling started to subside and I returned to work three months later. Eventually I went into a total remission for almost three years. At age 40 I married and at age 41 I got pregnant. I had to adjust my medication. The OB would tell me one thing about medication and the RA doctor would tell me something else. I was the go-between, so finally I gave my OB the RA doctor's number and asked them to come up with a plan and then let me know!! They agreed on a medication called magan which was safe for the pregnancy but did not keep the arthritis in check as well.
In the last month or so of pregnancy I went into a total remission and did not have to take any medication. I thought that since I was not on any medication, I would breast feed. My son had to be delivered by C-section due to pregnancy induced hypertension (which really was a blessing in disguise- since he was 10 & 1/2 lbs). I started to breast feed BUT shortly there after the RA came flaring back. Imagine trying to hold and breast feed a 10 & 1/2 pound baby with swollen hands just after throwing up yourself and dealing with a huge incision. Since I had started to breast feed the pediatrician wanted to continue the breast feeding until he was six weeks old. I was put on motrin since it was the least offensive to him but it did not control the RA as well. My concern at that time was what was best for him.
We were in the hospital for five days and we were notorious. He was almost twice the size of all the other babies in the nursery and had wild, massive blond hair. When I introduced myself to one of the other mother's she replied" Oh you are the mother of that ten pounder".
When we went home we needed help. My husband had arranged for his vacation and my mother came every day after work. I thank God for him and for his safe delivery. He is truly a Blessing. We are old enough to be his grandparents and have at times been mistaken for his grandparents. One lady said to him something about being out with grandma and grandpa" and he looked at her strangely and said "that's mommy and daddy.
"With God all thing are possible." RA and age were hardships but not obstacles to my dream of a family.
p.s. do not eat bean burritos while breast feeding. We found out the hard way!!!
At 28 ended up pregnant with my first son. This was simialar to the first pregnancy. Although I was only able to breast feed him for three months due the pain of to trying to lift him in the middle of the night, it was not worth the risk of dropping him! He has no RA problems.
At 34 I became pregnant with my third child. It was a miscarraige.Three months later we convieved our forth it was another great pregnancy, I stopped taking the Embrel as soon as I found out about being pregnant and by the second Trimester was once again perscription free. My boy just turned one in January and I'm still breast feeding. It was just about 2 months after giving birth that the pain returned however this time it was able to be side stepped somewhat by Prednisone once again along with Tylenol Artheritis, every night before bed. I use a front pack to carry him and a back pack once he got bigger. It's been wonderful!
I now stay at home with the children, which has turned out to be a full time job! We are currently trying for our fifth child (wish us luck!), I'm not sure who they did the study on! ;-) Somedays it's a lot of work and harder because of pain or tiredness but the kids have learned to help out when needed and to be careful with mommy's ouchy joints...daddy does the wrestling in this house!
My doctor told me that I had to be off methotrexate for three months before getting pregnant so if what B posts is correct, that is also something that needs to be given more copy.
This is a very emotional and in-depth process and I am floored at the 'wrap-up' article. Please, if you are considering starting a family and you have RA, speak to many doctors to make the most informed decision for you, your family, and your potential child.
I can say that I had a great pregnancy, pain was less. Few times i took ibuprofen or paracetamol.
My son now has 18 months , is in good health.
He was born spontaneous and I can say that after he was born, the pain was not a lot. Only the hands (because as you can see one uses them a lot, to carry it, change him.ecc)
I hope many other women will try to have a family, do not stop yourself because you have RA. A new life will give you the strength to continue living.
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