Pregnancy and Arthritis


  • The best thing to do is to plan your pregnancy and discuss your plans with your Rheumatologist . This is because your treatment plan may need to change depending on what medications you are taking.
  • Some of the medications you may be taking will need to be stopped or changed prior to conception.
  • Apart from lupus, most forms of arthritis do not increase the risk of problems in pregnancy or risk of harm to your baby.
  • 1/3 of patients with RA or PsA experience a flare of their arthritis during pregnancy. A shared decision that you make with your Rheumatologist is unique to each patient.
  • The decision to stay on treatment through pregnancy depends on how severe your arthritis has been in the past, how quickly you have previously had flares off medication, and what (if any) risk there is from medication to the baby
  • “We hope that discussions with your Rheumatologist will take an individualised approach in order to create a shared decision making 1,2 care plan and that we can help support the evidence of  ‘’Well mother, well baby”.

Arthritis is not a genetic condition but does tend to run in families, therefore the chances of passing your condition onto your child is very small.



  • It is advised that you should take folic acid daily (0.4mg) 3 months before getting pregnant until 12 weeks into pregnancy (this reduces the risk of spina bifida and is recommended for all women).
  • If you are taking Sulphasalazine during conception and pregnancy you should take a slightly higher dose of folic acid daily 1mg per day for 3 months before getting pregnant and until 12 weeks into your pregnancy.
  • If you are taking steroids then it is recommended that you take calcium and vitamin D supplements to help prevent osteoporosis.
  • Iron supplements can be taken safely if your haemoglobin level is low.


When is a good time?

  • It is best to plan and try for a baby when your arthritis is well controlled so that the drugs can be reduced to the safest and lowest possible dose.
  • Anyone who smokes is urged to stop prior to conception as there is an increased risk to the baby of restricted growth and cot death.
  • It is also important that you stop drinking alcohol and stop taking any recreational drugs.
    It is also best to be in a health weight range in order to conceive more easily and be at less risk of pregnancy complications.
  • If you have other conditions such as thyroid disease (hypo or hyper) and diabetes these should also be well controlled.



  • If you wish to get pregnant then you need to look at which medications both you and your partner are taking, as some can affect or harm a developing baby. Many medications will say on the label to avoid in pregnancy, and often this is more to do with the lack of scientific data and evidence rather than strong evidence to say there is a risk of harm.
  • Discussing this with your Rheumatologist will allow time to change medications if needed so that both you and your baby can be as healthy as possible. However you shouldn’t just stop taking your medication before discussing it with your Rheumatologist. They will be able to prescribe the safest dose of medication for you.
  • Some drugs must be stopped due to the risk of harm to the baby. All medications should be discussed with your Rheumatologist. Medications also need to be discussed if your partner is on arthritis medication.

Below is a table indicating drug compatibility in pregnancy and breastfeeding with additional notes underneath.


Medication name


Safe in pregnancy? Safe in breastfeeding?
Azathioprine Yes Yes
Ciclosporin No No
Cyclophosphamide No No
Hydroxychloroquine Yes Yes
Lefunomide No No
Mycophenolate Mofetil No No
Methotrexate No No
Sulfasalazine Yes Yes
Steroids Yes Yes
IVIg Yes Yes
Paracetamol  Yes  Yes
Codeine Yes Not advised
Tramadol Yes Yes – short course
Amitriptyline Yes Yes – low dose
NSAID Not advised/ caution Yes
COX-2 inhibitors No No
Low dose aspirin Yes Yes
Bisphosphonates No No
Nifedipine Yes Yes


Additional comments:

Azathioprine: Safe at doses <2mg/kg/day.

Biologics: If you are on any biologic please discuss your medications with your Rheumatologist when you are starting to think about planning for a baby, so that we can create a shared decision-making care plan that is right for you.

Bisphosphonates: Stop 6 months prior to conception.

Ciclosporin: Can be considered at the lowest effective dose.

Cyclophosphamide: This medication can reduce fertility in men and women. It should be avoided in pregnancy, and stopped at least 3 months before planning.

Leflunomide: This should be stopped at least 2 years prior to trying to get pregnant. A Leflunomide ‘washout procedure’ can be arranged with drug level blood monitoring. Providing the drug is undetectable, patients can conceive 6 months after stopping Leflunomide. There is a risk of birth defects and so reliable contraception should be taken with this medication if you are of child bearing age. It is often therefore avoided in young females. Men wishing to start a family should stop taking Leflunomide at least 3 months before planning a family and take a ‘wash out’ medication.

Mycofenolate Mofetil: Stop least 6 weeks prior to trying to get pregnant.  Patients with SLE on MMF are usually switched to Azathioprine.

Methotrexate: Stop at least 3 months prior to trying to get pregnant. Contraception must be taken whilst you are on this medication. In women treated with low dose Methotrexate within 3 months prior to conception, folate supplementation (5mg/day) should be continued prior to and throughout pregnancy

Nifedipine: Safe at doses <60mg/day

NSAIDs: Where possible should be avoided and stopped at 30 weeks. If considered necessary upon consultation with your Rheumatologist this should be prescribed at the lowest effective dose for the shortest possible time.

Sulfasalazine: Supplement with 5mg folic acid daily. It can lead to reversible reduced sperm counts in males.

Steroids: Relatively safe to use in pregnancy. If you are on steroids during your pregnancy then you have a higher chance of developing pregnancy related diabetes with high blood sugars (gestational diabetes) – this usually improves when the steroids are stopped. SLE patients on steroids have an increased risk of high blood pressure and pre-eclampsia in pregnancy.


What can I take that is safe for pain relief?

  • See the above table for guidance on safety of pain medications.
  • Physiotherapy and acupuncture can also be used as alternative therapies.
  • During labour, you should tell the anaesthetist if you have had arthritis issues with your back – especially ankylosing spondylitis as this may affect whether you can get an epidural or how easy this procedure will be.


How does pregnancy affect arthritis?

Pregnancy affecting your arthritis depends on which condition you have:

  • Rheumatoid arthritis is often quiet in pregnancy (in 2/3 cases) though may flare after your baby is born.
  • Osteoarthritis may become more painful as your load from the baby on your hips, back and knees increases.
  • Ankylosing spondylitis (AS) may cause low back pain in the 2nd trimester (weeks 13-24). Back pain starting during the last 3 months of pregnancy is usually due to the extra load of pregnancy rather than the AS

Common to all pregnancies, regardless if you have arthritis or not, lower back aches and pains are common.


The normal population risk for miscarriage is approximately 15%. There is an increased risk of miscarriage in some patients with lupus and antiphospholipid syndrome. If you have lupus or antiphospholipid syndrome please discuss planning your pregnancy with your Rheumatologist for more details as you may need to take extra medication e.g. low dose aspirin throughout early pregnancy.


It is encouraged that you still exercise in your pregnancy so that you can stay as healthy as possible. You may find non weight bearing exercises like swimming or cycling on a static bike beneficial as your pregnancy progress as these cause less pressure on your joints.


Breastfeeding has many benefits for your baby and this is encouraged. Your Rheumatologist will therefore try to keep you on medications that are safe in breastfeeding.
See the table above to see which medications are safe to take when breastfeeding.


After birth:

Living with and looking after a newborn baby is busy and tiring for every new mother. You may find that having arthritis adds another layer of stress. You may find that your arthritis has been well controlled during your pregnancy but that you have a flare after you have given birth and so may be sore and stiff.

You may find you want to pre-arrange extra help to be around the house and may benefit from physiotherapy and occupational therapy to give advice and help with daily activities.
If you flare shortly after giving birth you may benefit from a steroid injection to a joint, or from a short course of oral tablets along with physiotherapy. DMARDs may be re-introduced but you need to check if you can or cannot breastfeed with these.


Lupus and pregnancy:

Patients with lupus will be closely monitored during pregnancy as some have increased risk of complications, though most have a very successful pregnancy and delivery.
There is a higher risk of miscarriage with SLE and having anti-phospholipid syndrome also increases miscarriage risk. There is some evidence that taking low dose aspirin helps reduce some of these risks and so your Rheumatologist and Obstetrician will discuss this with you.

There is also a risk that your baby could be smaller than normal or be born earlier than normal, and so you will be advised to have your baby monitored more closely in a more specialised centre.

If you have lupus that affects your kidneys or you have positive antibodies then you will have more frequent scans and appointments along the way.

If you have high blood pressure or kidney involvement there is an increased risk of pre- eclampsia. You will have your blood pressure monitored and urine regularly checked and you should tell your doctor if you have headaches or vision changes.