RA occurs frequently among women of childbearing age and many women who develop the disease during this period in their lives may still want to have children. The good news is that most women with RA have normal pregnancies and deliver normal, healthy children. However, it is important to plan your pregnancy carefully if you have RA. Many of the drugs that you take to control your symptoms may pose a risk to a developing fetus, so you will want to speak with your doctor and develop an action plan before you get pregnant. Some medications commonly prescribed for RA, such as methotrexate, must be ceased for at least 3 months before attempting to become pregnant.
Importantly, just because you have RA, it does not mean that your child will develop the disease. The risk of developing RA, even if you share the exact same genes with another person (such as an identical twin) is only about 15%, and we think that another environmental or other non-genetic factor must be present to trigger the disease in susceptible individuals.1
Changes in the immune system during pregnancy
Many changes occur in the immune system during pregnancy, partly in response to changes in hormone levels, such as estrogen, progesterone, and testosterone. Immune activities may be enhanced when there are low levels of these hormones and inhibited when there are higher levels, such as during pregnancy. During the nine months of pregnancy, when levels of hormones are high, RA symptoms may decrease, returning to pre-pregnancy norms after birth.2
How likely is it that my RA symptoms will clear up during pregnancy?
About 50% to 60% of women with RA may experience an improvement in symptoms during pregnancy. However, if you are pregnant and have RA, it may be hard to tell whether you have the symptoms of RA or common discomforts associated with pregnancy, including fatigue, swelling of feet, hands, or ankles, pain in joints, shortness of breath, or pain or numbness affecting one or both hands.1
What you should do before you get pregnant
The first thing you should do if you have RA and you are planning to get pregnant is to speak with your rheumatologist, as well as the doctor who provides you obstetrical care.
In addition to the general recommendations that apply to women who are planning to become pregnant, you should1:
- Review the RA medications that you take with your doctor(s) and determine which medications are safe to continue to take during pregnancy and which should be discontinued because they pose a risk to a fetus
- The disease-modifying anti-rheumatic drug (DMARD) methotrexate should be stopped at least 3 months before you try to get pregnant. Waiting 3 full menstrual cycles prior to conceiving will allow the body to fully recover from the effects of the drug. Men with RA who are taking methotrexate should also stop the drug for at least 3 months before conceiving a child.
- The DMARD leflunomide (Arava) should be stopped for at least two years before trying to get pregnant. Treatment with other drugs can be used to help eliminate leflunomide from the body more quickly. If you have RA and think you may want to get pregnant in the future, you should discuss use of leflunomide with your rheumatologist.
What to expect with pregnancy and parenting
If you have RA, you may experience an improvement in the symptoms of fatigue and pain. However, after you deliver, you may experience a return to pre-pregnancy levels or a worsening of these symptoms. It is also a good idea to prepare yourself for the changes that come with a new child, including frequent interruptions in sleep, anxiety, stress, and fatigue. Work closely with your rheumatologist and obstetrician and enlist the help and support of friends and family to help you meet the challenges of pregnancy and parenting.
RA treatment during pregnancy
If you experience a RA flare (worsening of symptoms) during pregnancy and require treatment, work closely with your rheumatologist and obstetrical provider to determine which medications are safe to use. Unfortunately, there is limited information on the safety during pregnancy of many of the drugs now used to treat RA. Additionally, some drugs, such as aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) can be used safely in the early stage of pregnancy, but not during later stages. You and your doctor(s) may decide that the benefits provided by some RA drugs outweigh the risks that they pose to you and your fetus.1
The DMARDs methotrexate and leflunomide should not be taken during pregnancy and if you become pregnant while taking one of these drugs, you should speak with your doctor immediately.1