Becoming a parent is one of the most exciting and overwhelming times in most people’s lives. But even more so if you, or your partner, has arthritis. Download the Arthritis & Pregnancy or you can also read the information on this page.
I have arthritis…is having a family possible?
Absolutely. It might require extra planning and patience, or not be quite as you pictured it, but becoming a parent is usually possible if you have arthritis.
The journey to parenthood can be uncertain and demanding, often both physically and emotionally, and sometimes more so if you are living with arthritis. Living with joint pain and other symptoms can make it challenging to care for a new baby or an active toddler. However, with proper planning and medical care, most people with arthritis can have safe, successful pregnancies and become loving, capable parents.
The first step on the path towards parenthood is to discuss your family plans with your rheumatology team before you start trying for a baby.
Does having arthritis make it harder to fall pregnant?
Conceiving a baby may take longer if you, or your partner, have arthritis but experts are not exactly sure how or why. Studies have shown that women with rheumatoid arthritis do take longer to conceive, often longer than 12 months. Experts aren’t sure why this is the case. It could be due to the disease itself or some arthritis medications, such as anti-inflammatory medications. Other factors such as lower sex drive due to fatigue and pain might also play a role.
There is very little known about whether fertility is affected by psoriatic arthritis and ankylosing spondylitis. Women with lupus may have a higher risk of complications during pregnancy but most are able to have children. See the section about lupus and pregnancy for more information. Whatever your type of arthritis, your rheumatologist can help guide you as you plan to conceive.
They can also refer you to other specialists, such as an obstetrician, to improve your chances of getting pregnant if you’re having difficulties conceiving. It can be a lonely, emotionally draining experience if it’s taking longer than you had hoped to fall pregnant, especially if you have ceased some of your medications in order to conceive safely.
It is estimated that as many as one in six couples in the Australian population have trouble conceiving, so if this is an issue for you you are definitely not alone. The good news is that advances in medicine and science have made treatments for fertility challenges more effective.
If you have any concerns about your fertility, speak to your GP or rheumatologist who can refer you to a fertility specialist.
Is there an increased risk of miscarriage or problems during pregnancy if I have arthritis?
Most studies have found that the rates of miscarriage for women with rheumatoid arthritis are no different from rates for women without arthritis.
There is also no increased risk of miscarriage if the father has arthritis. Most types of arthritis that are well controlled don’t increase the risk of complications during pregnancy or cause harm to the unborn baby.
Highly active, or poorly controlled, arthritis can cause risks for both you and your unborn baby so it is vital to work with your rheumatology team to find a management plan that works for you. Women with lupus can have a higher risk of miscarriage and other pregnancy complications, usually requiring closer monitoring from specialists.
See below about lupus and pregnancy for more information.
Can arthritis be passed on to my unborn baby?
For most types of arthritis the chance of your child having arthritis is low. Even though some types of arthritis appear to run in families, there are many other factors involved other than just the genes your baby inherits from you and your partner.
If you are worried, it’s a good idea to talk to your rheumatologist for more specific information about your particular type of arthritis.
We want to start a family – what do I need to consider?
Get the right advice – see your rheumatologist before planning for a baby Some of the medications used to treat arthritis can be taken safely before and throughout pregnancy. Some can be used at certain times during pregnancy. Others are harmful to a growing baby so shouldn’t be used during pregnancy. Some medications remain in your body for many months after you stop taking them so you may need to wait a while before trying to conceive.
If you or your partner has arthritis, make it a priority to talk to your rheumatologist at least six months before you start trying to conceive.
Your rheumatologist can give you advice about the safest combination of medicines to continue taking during conception and pregnancy, other treatments you could use while trying to conceive, and which medicines should be stopped before conception (and when you should stop them).
Suddenly stopping your medications could make your arthritis worse, which can cause health problems for both you and your baby. Always talk to your rheumatologist before you stop taking any of your arthritis medications. Remember, there are many arthritis medications that can be safely used before and during pregnancy.
Questions for your healthcare team
Here are some things to discuss with your healthcare team, such as your rheumatologist, rheumatology nurse and GP before you start trying to conceive:
- Are there any medications in my treatment plan that I should stop taking while I’m trying to fall pregnant or when I am pregnant? If yes:
– How long should I stop taking the medication(s) before I start trying for a baby?
– What are my other options to help manage my symptoms while I can’t take my usual medication?
- Are there any medications for arthritis that are safe to continue while I’m trying for a baby, and during pregnancy?
- Do I need any vaccinations before trying for a baby, or if my medications are changing?
- Should I be taking any particular supplements before trying to fall pregnant?
- When would be the best time for my partner and I to start trying for a baby?
- What is the best type of contraception we should be using while we’re waiting to conceive?
- Are there any particular tests I need before trying to conceive?
Your medical team should be able to work with you to come up with a treatment plan that protects the health of your unborn baby, while also keeping your arthritis under control. Be mindful that treatment plans may need to change, or you may need to try a range of different medications to find the right treatment for you during this period.
If you find it hard to talk openly and honestly with your doctor about your options or concerns, write down your questions before the appointment. You can also consider seeking a second opinion from another rheumatologist with a special interest in pregnancy
Does it matter how active my arthritis is before I conceive?
You might be eager to start a family but your rheumatologist only wants to talk about how to get your arthritis under better control. Why does it matter whether your arthritis is active if you’re trying to conceive? Conceiving while your arthritis is not well controlled or highly active can cause risks for both you and your unborn baby.
Having your arthritis well controlled may:
- make it easier for you to conceive
- reduce your chance of requiring a caesarean section to deliver your baby
- reduce the chance of your baby being born prematurely, or having a low birth weight
- prevent permanent joint damage and disability.
It is vital to work with your rheumatology team to find a plan that works for you and puts you on the path to a healthy pregnancy and baby.
What about men with arthritis?
If you are a man with arthritis and you are thinking about starting a family, your medications could also affect your fertility or your unborn baby. Most medications can still be taken but some may need to be stopped, possibly for several months, before trying for a baby. Some medications can reduce your sperm count, although this is usually reversed when you stop taking them.
Talk to your rheumatologist at least six months before you and your partner plan to conceive.
Your rheumatologist can give you advice about the best treatment plan to follow before conceiving. Be vigilant with contraception to prevent unplanned pregnancies until you are ready to conceive.
When is the best time to start trying for a baby?
The best time to start trying for a baby is when your arthritis is well controlled or stable. While you might get a sense of this yourself from monitoring your own symptoms, it is important you discuss with your rheumatologist whether your arthritis is stable.
If your arthritis is not well controlled, you may find it harder to conceive and there can be risks for both you and your unborn baby. Talk to your rheumatologist about the best management plan that will give you the best chance of achieving your goal of becoming a parent while also protecting the health of you and your baby.
You may also need to wait after stopping certain medications; for example methotrexate needs to be stopped at least three months before trying to conceive.
Stop smoking and avoid recreational drugs to reduce the risk of harm to your baby. Eat a healthy balanced diet, lose any extra body weight, start taking a folic acid supplement and lead a healthy lifestyle to further boost your chances of a healthy pregnancy.
What is the current evidence about medication safety for pregnancy and breastfeeding?
If you are planning a pregnancy it is vital to get an expert opinion from your rheumatologist about your medications as early as possible. Some arthritis medications are safe to continue before and during pregnancy. Other medications may need to be stopped as they may increase the risk of miscarriage or cause harm to a developing baby. Your rheumatologist will work with you to find the right arthritis management plan for both your health and the health of your unborn baby.
The current evidence about the safety of arthritis medications is summarised on the adjacent page. This is a general guide only. New information is being discovered regularly and advice may be updated. Use this table to discuss your medications with your rheumatologist and always follow their expert advice.
Unplanned pregnancy
If you, or your partner, have fallen pregnant unexpectedly, call your rheumatologist or treating doctor immediately.
If you are taking any of the medications from the Not safe column in the table on page 11 that are not safe during pregnancy, stop taking them as soon as you find out you are pregnant.
If you are taking any of the medications from the Generally safe or May be safe columns in the table below, continue taking them as usual until you speak to your rheumatologist. Do not stop taking these medications without first talking to your rheumatologist and getting the right advice.
- Some TNF inhibitors are recommended to be stopped in the later parts of pregnancy. Talk to your rheumatologist for more information.