How to Handle RA and Pregnancy

Pregnant and managing RA? Here’s what to expect and how to stay comfortable and in control.

Winnie Yu
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From “cankles” to crazy dreams, pregnancy can bring on all kinds of surprises, so if you have rheumatoid arthritis (RA), it’s natural to be stressed out about what pregnancy may mean for you. You may even be worried that RA will affect your growing baby.

Rest easy. “The majority of women with RA have safe and healthy pregnancies and can control the disease with medications that are pregnancy-safe,” says Eliza Chakravarty, MD, an associate member in the division of arthritis and clinical immunology for the Organization of Teratology Information Specialists in Brentwood, TN.

Here’s what you to need to know about pregnancy and having RA:

Good news! Your RA pain may subside.
Research shows that most women with RA—as many as 75%—will actually experience reduced arthritis pain during pregnancy. “In the remaining women, their disease activity stays about the same,” Dr. Chakravarty says. “So far, there’s no way to predict which women will get improvement and how much.”  

The reason for less pain during pregnancy? Special proteins are exchanged between the mother and her unborn child to ensure that the mother’s immune system won’t reject the new cells growing in the fetus. Researchers believe that in addition to taming mom’s immune system (which is overactive in those with RA), these proteins may also suppress inflammation, reducing the pain of RA.

You must talk to your rheumatologist before you conceive.
Some RA meds can pose a risk to the fetus, so Dr. Chakravarty recommends talking with your rheumatologist about “switching to medications with fewer associated fetal risks for at least three to six months before becoming pregnant.” If you’re taking an RA medication and find out you’re pregnant, contact your rheumatologist, who may tell you to stop your medication immediately. Certain medications unrelated to RA may be safer but should be taken with caution, and only if necessary. Still others shouldn’t be stopped abruptly, Dr. Chakravarty says.

Wearing the right footwear is crucial. Specifically, running shoes with a wide toe box and good arch support is key, “particularly for women with foot, knee and hip involvement in RA,” Dr. Chakravarty says. “The right footwear relieves pressure on the base of the toes, which is often involved in RA. Additionally, proper footwear helps maintain alignment of the feet and knees to prevent pain and discomfort.”

Exercise helps fend off aches and pains.
Physical activity helps strengthen your muscles and joints and prevents extra weight gain, which can worsen RA pain. Dr. Chakravarty advises walking briskly, riding a stationary bike and swimming. “This may be modified as the pregnancy progresses,” she adds.

April 2013