If you have recently been diagnosed with scleroderma and would like to start a family, the experts’ best advice is to wait. “No woman with scleroderma should attempt to get pregnant within three years of diagnosis, because disease complications [including hypertension and kidney damage] are likely to show up within the first three years of the disease and could complicate a pregnancy,” says Virginia Steen, MD, professor of medicine at Georgetown University Medical Center in Washington, D.C. “If you get through these critical early years of the disease without complications, it’s probably safe to have a baby,” she says.
First, however, it is important to speak with your doctor about your medications.
Aside from cyclophosphamide (Cytoxan), which can cause ovarian failure, most drugs used for scleroderma don’t have severe effects on fertility; however, some can affect an unborn child from the very earliest days of pregnancy. 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
Drugs continue to be a concern in the first trimester and throughout pregnancy. If you didn’t discuss medications with your doctor before you got pregnant, now is the time.
Some drugs, such as Cytoxan, can cause birth defects. Others, such as methotrexate, can cause miscarriages. 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.
There is some evidence that scleroderma may become more active during pregnancy, but this is debated. Dr. Steen has found the disease generally does not get worse during pregnancy, provided the woman has waited past the first three years of diagnosis to become pregnant – the most critical period in the development of complications, whether a woman is pregnant or not. On the other hand, scleroderma can affect later stages of pregnancy.
Second Trimester
If you have scleroderma and worry that your stiff skin won’t accommodate your expanding belly, that’s one worry you can put aside. Dr. Steen, who says she has never seen a woman whose skin interfered with or was damaged by pregnancy.
Likewise, concerns about Raynauds’s phenomenon – a common complication of scleroderma and some other arthritis-related diseases in which the blood vessels to the extremities go into spasms in response to cold temperatures or stress – can be laid to rest. Raynaud’s often eases as your blood flow increases in pregnancy. Heartburn, on the other hand, will probably get worse during pregnancy.
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