If you have rheumatoid arthritis and are considering having a baby, you're likely to have concerns. Will you pass the disease on to your baby? Will halting your meds make your arthritis worse? Which arthritis drugs will hurt your baby? We've got some answers for you on how to cope with rheumatoid arthritis and pregnancy.

1. Controlling Rheumatoid Arthritis Before Pregnancy is Essential

Planning ahead makes a difference to your rheumatoid arthritis and pregnancy. To feel your best during pregnancy and after your baby is born, get your arthritis under control as much as possible before becoming pregnant, advises the University of Washington Orthopaedics and Sports Medicine (UW Medicine). Maintain close contact with your rheumatologist, obstetrician and physical therapist and follow your treatment program diligently before, during, and after pregnancy.

2. Pregnancy May Improve or Worsen Rheumatoid Arthritis

Research shows that about 70 percent of women with rheumatoid arthritis go into remission when they're pregnant. Symptoms generally begin to improve or, in some cases disappear, from about the third trimester. For the other 30 percent arthritis symptoms stay the same or may become worse.

The jury's still out on why these changes in rheumatoid arthritis occur during pregnancy. Some suspected causes are changes in estrogen, or a change in the mother's immune system to protect the baby. Regardless of the reason, expectant mothers who go into remission view it as a blessing, especially as being pregnant will require going off certain drugs that help to relieve the painful symptoms of arthritis.

3. Pregnancy Changes Your Drug Routine

The main concern about altering arthritis medications during pregnancy lies with safety for the fetus, not the mother. If you're taking rheumatoid arthritis medications such as methotrexate, leflunomide, abatacept and rituximab you'll need to stop them before a planned pregnancy. Expectant fathers with arthritis should also stop taking methotrexate, cyclophosphamide or leflunomide.

You can continue to take tumor necrosis factor inhibitors and bisphosphonates right up until you conceive. Corticosteroids and analgesics such as acetaminophen are considered safe during pregnancy. And you should stop taking non-steroidal anti-inflammatory drugs (NSAIDs) by 32 weeks gestation.

Also, methotrexate reduces your levels of folic acid so you must take that folic acid supplement your obstetrician recommends.

4. Self Care Alleviates Arthritis and Pregnancy Symptoms

Managing medications is just one part of a well-rounded treatment plan for rheumatoid arthritis and pregnancy. Continue exercising to keep your muscles strong and your joints flexible, advises UW Medicine, and eat a healthy, balanced diet - which is good for both you and your baby.

Pregnancy can be stressful, which can worsen rheumatoid arthritis symptoms. Practice yoga, deep breathing and other relaxation exercises. Also, protect your joints - use assistive devices if you have to, and avoid activities that put excess stress on your joints.

5. Weight Gain May Worsen Arthritis Symptoms

Weight gain when you're pregnant can aggravate your hip or knee joints. While the extra weight helps to nourish your baby, you should be careful about how much you gain. The guidelines on weight gain from the American Pregnancy Association are:

  • 25 to 37 pounds if you were a healthy weight before pregnancy
  • 28 to 40 pounds if you were underweight before pregnancy
  • 15 to 25 pounds if you were overweight before pregnancy

If you're overweight, try to lose weight before you become pregnant: It improves rheumatoid arthritis symptoms, and protects you and your baby from pregnancy complications such as gestational diabetes and premature birth.

6. Flares Can Worsen After Pregnancy

Unfortunately, many women experience worse flares postpartum. Giving up rheumatoid arthritis medications during pregnancy and coping with carrying, bathing and lifting a newborn all conspire to make the situation worse. Consult your rheumatologist about getting back on a rigorous treatment plan as soon as possible after your delivery. Also, try to have a support network of family, friends and community support workers in place to ease your transition.

7. Some Arthritis Drugs Are Safe During Breastfeeding

Breastfeeding is the healthiest way to feed your baby. However, arthritis medications can be passed on to your baby through breast milk. Painkillers such as acetaminophen, ibuprofen, codeine, and diclofenac are safe when you're nursing. But, others such as aspirin, naproxen (Aleve®), and celecoxib (Celebrex®) are off limits. Get a full list of the drugs that are safe for you to take when you're breastfeeding.

8. Baby Doesn't Inherit Rheumatoid Arthritis

Having a family member with rheumatoid arthritis increases the risk of developing the disease, but you won't "pass it on" to your baby. According to the Mayo Clinic, the medical community doesn't believe you can directly inherit rheumatoid arthritis, only a predisposition to getting it.

Although rheumatoid arthritis and pregnancy can be challenging to cope with, many women survive the experience every year. Panicking and stressing out won't make things easier. Work closely with your medical team, try to be positive, reduce stress, and rely on family members and friends for help.


Journal: Rheumatic Disease Clinics of North America, Vol.15(2) pp. 213-39.

Date: 1989

Study: Rheumatoid arthritis and pregnancy

Website: https://www.researchgate.net/publication/20498110_Rheumatoid_arthritis_and_pregnancy

Authors: G. L. Klipple, F. A. Cecere