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Smiling at Life: The Challenge of Being a Mother with Rheumatic Disease

Smiling at Life: The Challenge of Being a Mother with Rheumatic Disease

Many women with rheumatic diseases have normal pregnancies. However, it is difficult to predict in advance what effects the physical changes during pregnancy will have on rheumatic diseases in individual cases, and vice versa. These effects also depends on the specific clinical condition. About two out of three women with rheumatoid arthritis have fewer symptoms during pregnancy than before


– regardless of the duration and severity of the illness. However, there are cases where joint swelling and pain may not resolve in the first trimester of pregnancy. 

Under favorable events, joint function can improve so much that fewer or no medications are needed until birth. However, other women may require drug therapy throughout pregnancy, which should be discussed with a rheumatologist.

Managing Rheumatoid Symptoms During Pregnancy: What to Expect and How to Get Support

The symptoms change little during pregnancy. In a third of pregnant women, back pain and pain at the attachment points of ligaments and tendons, such as in the chest and pelvic area, increase, especially in the middle of pregnancy. Inflammation, such as in the hands or knees, often decreases during pregnancy.

In the case of currently inactive lupus disease and without severe organ involvement, therapy often does not need to be changed. During pregnancy, in addition to normal prenatal care, regular lupus activity checks are advisable.

If you are a rheumatoid patient, seeking close support and advice from a rheumatologist throughout your pregnancy is best. Complaints such as fatigue, back pain, swollen joints, or numbness in the hands, which even healthy women experience during pregnancy, can then be better classified.

Want to get Pregnant, let’s PLAN

If you want to have children, it is a good idea to plan pregnancy during a calm phase of the illness and to discuss this with the treating rheumatologist and the gynecologist at an early stage. It can also be clarified whether the current therapy is absolutely necessary in its current form or can be adapted for pregnancy. Concomitant illnesses such as high blood pressure, diabetes or thyroid disease should be well-controlled before pregnancy.

What If, as a Rheumatoid Patient, I Become Pregnant Unplanned?

If women with rheumatoid disease become pregnant unplanned and take medication, it is particularly important to clarify as quickly as possible whether the medication can harm the unborn child and should therefore be switched to other medication.

However, it is now assumed that many medications do not carry an increased risk of childhood malformations. Some women worry because they were taking medication when they didn’t know they were pregnant. However, the following applies to the first two weeks: If a fertilized egg cell is damaged during this time, the body will reject it or it can compensate for the damage, and the embryo will regenerate.

All women who want to have children are recommended to start taking folic acid supplements four to eight weeks before the desired pregnancy. Folic acid has been proven to reduce the risk of certain childhood malformations. 


What Are the Risks for Pregnant Women with Rheumatoid Disease and their Children?

Most rheumatic diseases have no impact on the child’s health. This also applies if therapy with suitable medication must be continued during pregnancy. Good control of the disease is important to prevent complications.

According to current knowledge


, childhood malformations do not occur more frequently if the mother suffers from rheumatoid disease.

Some studies have found higher rates of preeclampsia and cesarean delivery in pregnant women with active rheumatoid arthritis


Their children were also more often born with a low birth weight, although this was not confirmed in all studies. Children of women with lupus erythematosus are usually born healthy, but on average slightly earlier and with slightly lower birth weights. Preeclampsia is more common during pregnancy when the disease is active. In some women with lupus erythematosus.

There are so-called antiphospholipid antibodies in the blood, which cause the blood to clot more quickly. From the 20th week of pregnancy onwards, regular blood pressure measurements and protein determinations in the urine are particularly important. The child’s growth and placental function should be checked repeatedly from mid-pregnancy onwards with a Doppler ultrasound examination.

Rheumatoid Medication During Pregnancy

Smiling at Life: The Challenge of Being a Mother with Rheumatic Disease

There are a number of rheumatoid medications that, according to available data and experience, should under no circumstances be taken during pregnancy. They should be stopped well before pregnancy. Others may only be taken up to a certain point in time, some only specifically when an illness flares up and as prescribed by your doctor.

It is important that you seek specialist advice to clarify in your specific case which medication you can take and in what dosage during pregnancy and breastfeeding without harming yourself or your child.

Can Women with Rheumatoid Have a Vaginal Birth, or is a Cesarean Section Necessary?

Most women with rheumatoid diseases can give birth naturally. If mobility is not too severely restricted, this also applies to women with Bechterew’s disease (Ankylosing spondylitis (AS) is a rare type of arthritis that causes pain and stiffness in your spine). It is best to discuss with the midwife and doctor before the birth which birth positions there are that relieve the strain on the back and which remedies can be used to relieve pain during birth. 

Compared to healthy women, women with rheumatic diseases are significantly more likely to have a cesarean section. Often this is not due to the disease itself but is due to a suggestion from the obstetric team or the wish of the pregnant woman. If mobility is impaired due to painful joints or the muscles are weakened, some women feel unable to cope with severe labor pains or a prolonged birth.

As a rule, the children are born healthy and full-term around the due date. For children born to women with lupus erythematosus and SSB antibodies, it is recommended to have an electrocardiogram taken once after birth to check the heart rhythm.

Breastfeeding and Rheumatoid

You can breastfeed your child if the disease is stable and no medication needs to be used to prevent it. Breastfeeding is not recommended for certain medications. However, they can often be replaced by other medications that can also be taken while breastfeeding. Anti-inflammatory drugs and painkillers, which only have a very short-term effect, are not a concern.

Breastfeeding has no influence on postnatal rheumatoid flare-ups in cases of rheumatoid arthritis. Get advice from your obstetrician or a qualified and experienced midwife about breastfeeding.

If you’re struggling with getting pregnant while managing a rheumatoid disease, know that you’re not alone. It can be a challenging journey, but with the right support, guidance and favor, it’s possible to achieve your dream of having a baby. At Physiowell, our team of experienced physiotherapists and chiropractors are here to help you navigate this process. We offer a range of services to support the treatment of  Rheumatoid Arthritis and overall well-being, including prenatal care, and postpartum rehabilitation. Contact Physiowell today to learn more about how we can help you on your journey.



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