health Maybe baby? Thinking of creating a new addition to your family? Read on to find out how your medication and arthritis symptoms might affect your pregnancy Words: Victoria Goldman T rying for a baby can be an exciting time after all, theres nothing more magical than planning your future as a family andimagining your life with a little onein tow. While theres no reason that you cant have a healthy baby if you havearthritis (although there is a small risk of passing arthritis on), you might need to take afew extra precautions as your symptoms may affect your pregnancy and vice versa. dr Virginia Beckett, spokeswoman for the Royal College of Obstetricians and Gynaecologists, stresses the importance of preparing in advance. discuss the possibility of a pregnancy with your rheumatologist before you start trying to conceive and use effectivecontraception until you are ready, she says. It all comes down to planning carefully, making sure your arthritis care is optimised and your symptoms are as well controlled as possible. Systemic lupus erythematosus (SLE, lupus) behaves differently in pregnancy from other types of rheumatological conditions. It carries a higher risk of complications, so if you have this its particularly important that you seek advice from your doctor before trying to conceive. Its also advisable to try for a baby when your symptoms are going through a quiet phase, so you can safely reduce the medicines you need to take. be medicine smart Some arthritis medicines can affect fertility (in both men and women) or the development of a growing baby during pregnancy. They may also increase the riskof miscarriage. a rheumatologist may advise you to adjust the doses of your medicines or even stop taking them completely for three to six months before you try for a baby, as well as during the pregnancy. Even if your medicines dont affect pregnancy, your doctor will usually try to prescribe the lowest effective dose possible, to keep your baby safe and your symptoms under control. Many other medicines, including some over-the-counter painkillers that you can buy from pharmacies and supermarkets, should be avoided duringpregnancy these include non-steroidal anti-inflammatory drugs (nSaIds) such as ibuprofen. Instead, use paracetamol for pain relief, or consider non-medicated treatments for example, hot and cold pads, physiotherapy or acupuncture. also, keep exercising gently and regularly, on the advice of your doctor or midwife, to keep your joints flexible. Expand HIdE the lowdown Below maloney, 30, from south xheidi is a list of some drugs on drugs during used for arthritis and their wales, is mum to a sevenpregnancy implications during pregnancy, month-old. she was diagnosed but itsystemic lupus in 2012. with is not an exhaustive list and should just be used as a Before the pregnancy, my guide. consult your GP before rheumatologist managed to taking any drugs if you are get my symptoms well under considering becoming pregnant control. I had to stop taking or breastfeeding. azathioprine six months before trying for a baby, but Do not take during pregnancy continued with steroids and n adalimumab hydroxychloroquine. I was n anakinra worried that I would have n cyclophosphamide trouble conceiving, or even face n etanercept miscarriages, but I fell pregnant n infliximab straight away. n leflunomide I felt fantastic the best I had n methotrexate been for years. All of a sudden n mycophenolate my hair was thickening, my n Penicillamine joints were ache-free, and I was n rituximab full of energy. I was seen every Do not take while four weeks at the hospital, to breastfeeding monitor my pregnancy closely. n ciclosporin aspirin and a They gave me n cyclophosphamideinjection daily blood-thinning n leflunomide during pregnancy, and for six n methotrexatebirth. I also had weeks after the n mycophenolate regular scans to check my babys growth and blood flow. Might be prescribed I had Logan on 6 June 2014, n Paracetamol at 39 weeks and one day. I had a n some steroids slightly tricky forceps delivery, n low-dose aspirin for those due to his heart rate dropping with lupus during labour, but he was n certain nsaids like perfectly healthy. ibuprofen or indometacin Unfortunately, since giving Ask your doctor some lupus birth, I have had n azathioprinetiredness, hair flare-ups, with n hydroxychloroquine loss, and aches and pains. I need n sulfasalazine rheumatologist to go back to the to see if I should up my meds. taking supplements From three months before you try for a baby until the 12th week of pregnancy, mums-to-be should take a daily 400mcg folic acid supplement. This reduces the risk of your baby developing spina bifida, a defect in the spinal canal. Only take a folic acid supplement that is specifically formulated for pregnancy to make sure it doesnt contain any other nutrients (vitamin a, for example) that can harm your developing baby. If you have been taking methotrexate or sulphasalazine which can affect your bodys supply of folic acid you may be given a higher folic acid dose on prescription. If you are on steroids, you may need calcium and vitamin d supplements as well, to keep your bones as healthy as possible see your Gp for advice. Rheumatoid arthritis flareups may subside during pregnancy testing times Some women need extra scans and tests to make sure that their pregnancy is progressing smoothly. If you have lupus, for example, your doctor will monitor you carefully to keep a check on your health, says dr Beckett. Lupus puts you at a higher risk of miscarriage and stillbirth, premature delivery and pre-eclampsia. However, this depends on the lupus type and severity. You may be prescribed daily aspirin and heparin to reduce the risk of blood clots and complications. around 30 per cent of people with lupus carry anti-Rh antibodies (immune system proteins), which are occasionally passed to the baby during pregnancy. These antibodies can sometimes cause atemporary rash or heart problem called neonatal lupus syndrome when the baby is born. Even if you do have anti-Rh antibodies, there is only a small chance that your baby will be affected, but your doctor will monitor your babys heart regularly. If you have already had a baby with neonatal lupus syndrome, theres a higher risk that this could occur in future pregnancies, so its important to discuss the possibility with your lupus specialist. Up to 30 per cent of lupus sufferers also carry antiphospholipid antibodies, which can cause miscarriage or slow the babys growth in some pregnancies so you should be tested for these, too. aches and pains pregnancy affects arthritis in different ways. Most pregnant women experience fatigue, especially in the first 12 weeks, and if you already feel fatigued as part of rheumatoid arthritis (Ra), this is likely to get worse at the start of your pregnancy. aside from this, if you have a mild form of the disease, it is likely to remain mild through pregnancy, according to a study in arthritis & Rheumatism. Rheumatoid arthritis flare-ups may subside during pregnancy around 70 per cent of women with Ra experience an improvement in symptoms from the second trimester, according to J Bruce Smith, Md, at Thomas Jefferson University, USa. However, osteoarthritis of the hips and knees often worsens as a result of weight gain and the growing baby. With some forms of arthritis, such as ankylosing spondylitis, there is no consistent pattern. during pregnancy, women produce the hormone relaxin, which softens all the ligaments in the pelvis, says dr Beckett. This causes the joints to move around, so even women who dont havearthritis tend to experience aches and pains. Osteoarthritis can worsen inpregnancy, as the joints are already out of balance. With rheumatoid arthritis, around 75per cent of pregnant women notice an improvement or significant remission, but 90 per cent get a flare-up in the first six weeks after the baby is born. With lupus, theres no particular pattern, but 40-60 per cent of women do experience a flare-up. Expand HIdE xheidi maloney,full of i was 30, from south wales, is mum to a sevenenergy month-old. she was diagnosed with systemic lupus in 2012. Before the pregnancy, my rheumatologist managed to get my symptoms well under control. I had to stop taking azathioprine six months before trying for a baby, but continued with steroids and hydroxychloroquine. I was worried that I would have trouble conceiving, or even face miscarriages, but I fell pregnant straight away. I felt fantastic the best I had been for years. All of a sudden my hair was thickening, my joints were ache-free, and I was full of energy. I was seen every four weeks at the hospital, to monitor my pregnancy closely. They gave me aspirin and a daily blood-thinning injection during pregnancy, and for six weeks after the birth. I also had regular scans to check my babys growth and blood flow. I had Logan on 6 June 2014, at 39 weeks and one day. I had a slightly tricky forceps delivery, due to his heart rate dropping during labour, but he was perfectly healthy. Unfortunately, since giving birth, I have had some lupus flare-ups, with tiredness, hair loss, and aches and pains. I need to go back to the rheumatologist to see if I should up my meds. Labour and beyond Your arthritis shouldnt affect the delivery of your baby. However, if you cant open your hips wide enough called poor abduction of the hips this may affect your chances of having a natural labour. Speak to your midwife about different positions in childbirth to keep you comfortable. If you have back problems, you may be able to have an epidural for pain relief. Once your baby has arrived safely, deciding whether to breastfeed or bottle feed is your next choice. While breast is best if you are able and happy to do so, it may not be possible depending on the type of arthritis medication you are on. Some can leak into breast milk and may affect your babys health. If your rheumatologist advises that you go back onto your medicines straight away, bottle feeding may be the best solution for you and your baby. Women with some forms of arthritis often find that their symptoms flare up again in the weeks after the birth. You may need extra help from family and friends with simple tasks such as feeding, changing, dressing and washing your baby. Think about ways of adapting your home as well, such as setting up a changing table downstairs, so you dont have to keep going up and down the stairs during the day. find out more For further info on pregnancy and arthritis, call our free helpline on 0808 800 405.