Health Blooming marvellous Getting pregnant can be an exciting time but you might have some worries about how arthritis may affect your pregnancy. Heres what you need to know words: Tracey Lattimore S 1 tarting a family is a wonderful time for most people theres all the excitement and anticipation of a baby, and all the possibilities that a new life will bring. If you have arthritis, however, you may have worries about how you will manage your condition during pregnancy and beyond. And how will your medication affect the chances of you becoming pregnant? Getting pregnant Anyone trying to get pregnant should avoid taking unnecessary drugs that includes medicines such as ibuprofen, as high doses can potentially cause a miscarriage oraffect your chances of conceiving. Ifyou have rheumatoid arthritis, many of the medications that you may be taking, such as cyclophosphamide, can affect pregnancy and your fertility. Methotrexate should never be taken during pregnancy, as it may harm the baby, but certolizumab pegol is considered safe. Medics, however, advise that you should never stop taking your arthritis medication without first talking to your GP. Consultant rheumatologist DrRod Hughes advises talking to your doctor or your specialist before trying forababy, to find out how your arthritisandmedication could effect your pregnancy. The doctor will be able to give you advice about what medications are safe, he explains. With careful forward planning, its possible to change treatments to enable your arthritis to remain under control while having a safe pregnancy and a healthy baby. Some arthritis drugs, such as cyclophosphamide, can also cause fertility problems for men, but current guidelines suggest that its OK for men to take drugs such as sulfasalazine (with folic acid) or methotrexate, unless you and your partner have been trying to conceive for more than a year. After that, its best to speak to your specialist. Remember, certain drugs are important to prevent disease flares during pregnancy, which could cause harm to the baby, so its important to discuss each drug with your doctor. Managing your pregnancy 2 Nine months of carrying a baby is tiring for any woman, and even more so with arthritis. If you have problems with your back, these might be exacerbated, while weight gain will put more stress on your joints. During pregnancy, some joints become more flexible because of a hormone called relaxin, which widens the pubic bones and softens the cervix in preparation for birth, so take extra care. However, many women with rheumatoid arthritis find their flare-ups stop while pregnant. During pregnancy, some common medicines such as anti-inflammatory painkillers are discouraged as they can affect pregnancy, especially in the later stages close to delivery, says DrHughes. The hormone changes in pregnancy can make a big difference toarthritis sometimes making it much better, with less pain and inflammation, especially in rheumatoid arthritis. Butthis can be followed, after childbirth, by a flare in symptoms, which may need extra treatment. Its important to carry on doing your regular exercises to keep as fit and active as possible. Physical activity helps to protect the tendons and ligaments around the joints that can be affected both by arthritis and pregnancy. These are put under greater strain by the weight gain that comes with pregnancy, explains Dr Hughes. Strengthening muscles will help to support the joints of the lower limbs and back. It is important to do the correct exercises and not to overdo it or cause injury. There are special exercise classes for pregnant women, but even gentle activities such as walking and swimming are beneficial. Strengthening muscles will help to support the joints of the lower limbs and back Dealing with fatigue 3 Tiredness and fatigue are common in pregnancy, though you may well be familiar with these symptoms already thanks to your arthritis. After the birth, its crucial to give yourself time to rest, as the demands of a new baby are high. You need to be prepared for flare-ups, as these often happen a few weeks after birth, once your hormones have settled. If you can, arrange for extra help from friends and family, and try to nap when your baby does. Giving birth 4 A normal delivery should be possible for many women with arthritis, although arthritis in your hips or lower back may cause additional pain during labour. For women with rheumatoid arthritis who have hip problems or altered pelvic measurements, delivery positions may need to be discussed beforehand. If you have no pelvic problems, however, a squatting position is better than lying on your back. Water can help ease pain, as well as help you change position and move around, so spending some of your labour in a birthing pool might be an option. If you can manage a semi-kneeling position as if youre proposing to someone it will help to open your pelvis really wide. Breastfeeding 5 If you choose to breastfeed, its important to position yourself correctly, as holding your baby for a long time can cause aches and pains. Lyndsay Hirst, chartered physiotherapist from Your Pilates Physio (yourpilatesphysio.com), says that making sure you are comfortable will allow for a better experience for youand baby. Feeding pillows are a brilliant aid to use to allow you freedom to move your arms, as cradling the baby could cause the shoulder and elbow to stiffen and become uncomfortable. If you dont have a feeding pillow, then placing a couple of pillows under the baby can be just as effective. I would also suggest placing some support, such as a cushion or a rolled up towel, around your lower back. Make sure you avoid constantly looking down at the baby keep lifting your head and looking up to allow the joints in your neck to stretch and move, and turn your head from side to side to make sure you dont stiffen your neck. A physiotherapist can advise on how to hold, dress and feed your baby, as stiffness in your joints can make these tasks more difficult. In terms of medication, Dr Hughes says that many drugs, including those for arthritis, cannot be taken while breastfeeding. Anti-inflammatory drugs NSAIDs such as aspirin and ibuprofen may pass into breast milk when taken in high doses, and should be kept to a minimum or avoided while breastfeeding. It is always best to speak to your doctor, who will be able to advise on medications that wont affect your breast milk. Methotrexate can pass into your milk, so you should not breastfeed if you are taking it. Your specialist will be able to advise on the safest drugs to take while breastfeeding, as its important not to wait until you have a flare-up before resuming your medication. Getting pregnant and having a healthy baby are possible with arthritis, and with a bit of pre-planning, you can make your nine months and beyond a healthy and happy time.