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.
Below is a table indicating drug compatibility in pregnancy and breastfeeding with additional notes underneath.
|Safe in pregnancy?||Safe in breastfeeding?|
|Tramadol||Yes||Yes – short course|
|Amitriptyline||Yes||Yes – low dose|
|NSAID||Not advised/ caution||Yes|
|Low dose aspirin||Yes||Yes|
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.
Pregnancy affecting your arthritis depends on which condition you have:
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.
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.
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.