Rheumatoid Arthritis During Pregnancy : What to Expect

Arthritis is a disease in which the joints start to swell up. It mainly affects the elderly and women. It is usually caused when the tissues either degenerate or get damaged due to an injury or accident.

Since rheumatoid arthritis is an autoimmune disorder, there are many concerns about how it impacts pregnancy. But before we get to that, let’s understand the disorder first.

What is Rheumatoid Arthritis?

The immune system of our body consists of cells and tissues which defend the body from infectious agents. It also heals our body when we suffer from any injury or health related problems.

Rheumatoid arthritis is a chronic disease of the immune system, in which some of the cells become abnormal and start to destroy the joints present in the body along with the harmful foreign particles.

When the joints are attacked, the tissue situated in the space between the bones start to swell. This inflammation of the joints is known as rheumatoid arthritis.

Due to the loss or degeneration of the tissues in the joints, they become loose and weak with the passage of time. This creates a lot of pain and tenderness in the affected area.

It usually affects women in their reproductive age. It is less likely to affect the women who have attained menopause.

How does immunity affect rheumatoid arthritis and pregnancy?

During pregnancy, the immune system of the body becomes weak to protect the baby in many cases.

Modulation of the immune system is necessary to provide a suitable environment for the fetus.

This weakening of the immune system reduces the symptoms of rheumatoid arthritis. Hence, the swelling and tenderness subside during this time.

A study suggested that pregnancy can reduce the effects of rheumatoid arthritis in women. This may be because of the changes in the working of the immune system due to the hormones in pregnant women.

Rheumatoid Arthritis During Pregnancy

Who is prone to developing rheumatoid arthritis in pregnancy?

Rheumatoid arthritis may be hereditary in some people. The changes in the immune system could be associated with the genes present in the body. So people containing such genes may be prone to this disease.

Women who suffer from preeclampsia (a pregnancy disorder characterized by high blood pressure along with a high amount of protein in the urine) are at a high risk of developing rheumatoid arthritis.

Which phase of pregnancy can rheumatoid arthritis affect?

Arthritis can have different effects on the three phases of pregnancy. If a woman has arthritis before conceiving, there is a high chance that the effects of the disease may improve during the first trimester of pregnancy itself.

However, there are various studies which have found out that the majority women undergo a normal delivery and both the mother and child are healthy.

Which Symptoms of Rheumatoid Arthritis May Affect Pregnancy?

The most common symptoms of Rheumatoid arthritis that affect pregnancy include:

Pain

Pregnant women may experience a lot of pain in the joints, especially in the first trimester. A sudden flare of pain is usually felt which may come and go and anytime.

Stiffness

This is characterized by the inability to move the body parts. This happens due to the swelling of joints. The body becomes rigid, and pain is felt on moving the joints, especially in the knee, hip, ankle, and shoulder.

Tenderness

Tenderness is the sensitivity to pain. It is a sign for indicating a health-related problem in the body.

Fatigue

The patient may feel extremely tired in this. This is another symptom of rheumatoid arthritis which is observed in the first trimester. However, fatigue improves after the second trimester.

Inflammation

It is also known as swelling. This occurs because the immune system sends cells to attack the joint. In response to this, the tissues of the joint swell up.

In addition to these, the women may feel increased discomfort because of an increase in the body weight due to pregnancy. This may also affect the spine, which further leads to other health related problems and risks.
This disease is diagnosed by blood tests, X-rays, MRI (Magnetic Resonance Imaging)scan or ultrasound scans.

What are the risks of rheumatoid arthritis that may affect pregnancy?

Various research studies have examined the link between rheumatoid arthritis and health outcomes in pregnancy.

1. Drugs taken to treat arthritis may have adverse effects

The drugs taken during rheumatoid arthritis by a pregnant woman may enter the fetus’ body while breastfeeding. These drugs may be harmful to the baby and hence should be avoided.

Using DMARDs or Disease Modifying Anti-Rheumatic Drugs increases the risk of preeclampsia in pregnant women.
Preeclampsia is a health condition which causes swelling along with a high blood pressure. It is a serious disease and can even be fatal.

2. Incidence of rheumatoid arthritis may affect birth outcome

Interleukins, which are the cells secreted by the white blood cells, increase in number during pregnancy. Outcomes of studies indicate that due to this hike, the baby may either be born with a higher or lower weight than normal.

Another effect of maternal rheumatoid arthritis on the health of the newborn is that the baby is small as compared to those babies who are born to healthy mothers.

3, Rheumatoid arthritis during pregnancy may affect postnatal care and lactation

Rheumatoid arthritis poses a risk during the delivery of the baby as it increases the chances of a premature delivery. Also, this would mean that caesarean delivery would take place instead of a normal delivery which could be dangerous for the mother.

There may be a risk of infection after delivery due to the weakened immune system. Until the body does not return to its normal functioning, medicines such as antibiotics should be taken to avoid this.

Breastfeeding for a longer period helps in decreasing the risk of this disease.

4. It may fuel postpartum depression

Postpartum depression is the depression in women after the childbirth.

Studies have found that women suffering from diseases such as arthritis are at a greater risk of developing postpartum depression. This may be because of the continuous pain in joints among patients with rheumatoid arthritis.

5. It may affect fertility

Both men and women who have rheumatoid arthritis may need to consult a doctor before trying to have a baby.
The medicines taken during this disease contain chemicals which remain stored in the body, and they need to be removed to improve the fertility.

Rheumatoid arthritis does not affect the chances of becoming pregnant. It does not create any problem in women who are trying to conceive. However, it may take them a longer time to do so due to impaired sexual functions.

A study reported that women who have rheumatoid arthritis showed a reduction in fertility and their pregnancy was delayed.

This disease may also hamper the fertility in men. It has been found to decrease the sperm count and impair the process of spermatogenesis (formation of sperms).

6. It may impact subsequent pregnancy

Studies have shown that complications in pregnancy such as premature delivery and vaginal bleeding among others may be observed in women with rheumatoid arthritis.

Can Pregnancy protect from Rheumatoid Arthritis?

Pregnancy can affect the development of rheumatoid arthritis as well.

Certain studies have shown that pregnancy could reduce the risk of rheumatoid arthritis.

The immune system consists of immunoglobulin. It is a type of protein which acts as an antibody and kills the antigens.

During pregnancy, the galactosylation of the immunoglobulin G takes place. This prevents the growth of the disease and improves the health condition.

A study reported that the risk of rheumatoid arthritis decreases further if the women are young. It also stated that the risk was lower in women who had a less gap between two subsequent pregnancies.

Pregnancy has been found to suppress the production of antibodies of the immune system. This makes the disease inactive.

Once the birth of the child has taken place, the disease which was earlier under control may get reactivated due to the resumed functioning of the immune system.

One reason for this is that the level of anti-inflammatory cytokines increases during pregnancy. This reduces the inflammation and controls the pain, stiffness and other symptoms of arthritis. However, they may again decrease or come back to normal postpartum, as suggested by a study.

Female sex hormones such as estrogen show positive effects on this disease. Since the levels of these hormones are very high in a pregnant woman, the effects of arthritis remain hidden. This is the reason why women who reach the age of menopause can consider a hormone replacement therapy if they have rheumatoid arthritis.

Medications For Rheumatoid Arthritis: Which to Consider & Which To Avoid In Pregnancy?

Disclaimer: This lists of medicines/herbs, mentioned below, have been compiled based on the research available. This list is developed for information purposes; do not substitute or take it as medical advice. Please consult a health practitioner for suitable treatment for rheumatoid arthritis in pregnancy.

Taking in a beneficial and healthy dose of medicines which are safe for the mother as well as the baby is very important. The medicine should be able to limit the symptoms of rheumatoid arthritis effectively without harming the health of the child.

For this purpose, anti-inflammatory and immunosuppressive drugs are used.

However, not all medicines are safe during pregnancy. Some may cause defects in the newborn child.
The drugs and medicines which have been proved to be dangerous for the mother and the baby include:

NSAIDs

It stands for Non-Steroidal Anti-Inflammatory Drugs. These are taken to reduce inflammation during arthritis.

They are considered to be safe during the first and the second trimester of pregnancy. On the contrary, they should be avoided in the third or the last trimester.

This is because they interfere with the implantation which is the attachment of the embryo to the wall of the uterus.

Methotrexate

Methotrexate is a drug used to treat rheumatoid arthritis either before conceiving or just after the onset of pregnancy. It is a type of DMARD (Disease Modifying Anti-Rheumatoid Drug).

According to some published studies, this could have disastrous effects on the baby. Usage of this drug leads to a higher risk of abortions and congenital disabilities in the newborn.

Medicines which can be considered safe and effective for the treatment of rheumatoid arthritis are:

Hydroxychloroquine

It is a commonly used antimalarial drug. It is used to treat many autoimmune diseases, rheumatoid arthritis being one of them.

Studies have found HCQ to provide with an effective way to treat this disease. It does not cause any congenital disabilities in the baby. Also, it does not play any role in the risk of abortions or premature deaths.

TNF inhibitors

TNF inhibitors are now being increasingly used in place of the conventionally used DMARDs. This, unlike methotrexate, does not cause an increased risk of congenital disabilities and spontaneous abortions.

It is a relatively safe drug. Another benefit of the Tumor Necrosis Factor Inhibitor is that the leakage of toxins present in this drug in the breast milk is almost negligible.

Corticosteroids

They are anti-inflammatory drugs used for curing the symptoms of rheumatoid arthritis. A commonly used corticosteroid during pregnancy is Prednisone. They are safe as long as used in low to moderate quantities.

Even the paternal exposure of DMARDs or Disease Modifying Anti-Rheumatic Drugs is not related to any defects or health related problems in the child.

Foods for Rheumatoid Arthritis Treatment During Pregnancy

Natural treatment of a disease is always better than the intake of drugs. The naturally occurring substances rarely pose a risk, while drugs contain certain toxins which may accumulate in the body and cause several health problems in the future.

Some safe herbs / fruits / spices are for rheumatoid arthritis treatment include–

  • Ginger – This is an effective natural remedy for inflammation in the case of arthritis. It also helps to control nausea in pregnant women.
  • Turmeric – Turmeric contains a chemical substance called curcumin. This substance shows an anti-inflammatory effect on arthritis without any side effects.
  • Rosemary – This herb is also anti-inflammatory and has wound healing properties.
  • Blackcurrant – The oil extracted from black currant reduces the level of TNF-alpha, a molecule responsible for inducing inflammation. It controls other symptoms of rheumatoid arthritis as well.
  • Avocado – Treatment with avocado combined with NSAIDs decreases the pain among women with arthritis.

What lifestyle changes to adopt to reduce the impact of rheumatoid arthritis in pregnancy?

Permanent changes in the lifestyle help in improving this disease and ensure a safe and painless pregnancy. The daily routine should incorporate some or all of the following tips.

The diet should be balanced and should consist of a high amount of carbohydrates and protein along with a low amount of fats. Fibrous food should also be included in the daily diet.

Consumption of alcohol and tobacco smoking has been found to be one of the risk factors for this disease. Avoiding them would help in preventing the symptoms from becoming worse.

A sufficient supply of vitamins and minerals should be taken in, especially vitamin D and calcium.

Calcium – Since rheumatoid arthritis leads to bone loss, it is essential that a sufficient amount of calcium is provided to the women who are pregnant. Calcium helps in the formation of bones which restores the lost tissues, which may treat arthritis to an extent.

Vitamin D – This vitamin is required for the uptake and utilization of calcium by the body. If vitamin D is not supplied to the body, even high amounts of calcium present in the body will go to waste as the body won’t be able to make use of it.

Pregnancy leads to a rapid gain of weight. Although this is unavoidable, women should take care that it does not exceed beyond the normal amount. The more a person weighs, the higher will be the pressure exerted on the joints of the body, especially in the knee and hip joint.

To prevent unnecessary increase in the body weight, exercise should be done on a daily basis. But only light stretching exercises should be a part of this workout. Strength exercises should be avoided at all costs.

Instead of taking the medicines regularly, natural methods can be tried. These include using an ice pack or a hot water bottle to provide relief from pain. Though this is a temporary treatment method, the effect can be seen instantly.

The joint(s) which is affected should be given adequate rest. This is very important because the body needs time to heal itself.

Even though the joints should be moved to prevent them from becoming stiff, the physical activity should be reduced during this time.

Minimum strain should fall on the joints. This means that women should abstain themselves from lifting weights or wearing high heels during pregnancy. The posture of the body should be improved.

Conclusion

To stop the disease progression in rheumatoid arthritis, the medicines should be taken according to the condition of the disease. The phase of pregnancy should also be taken into account while on medication.

People should always consult a doctor before, during and after the pregnancy for the mother and child to stay healthy. They would prescribe the required medicines which are safe and effective.

Rheumatoid arthritis can be managed in its early stages. So it is advised for women who wish to conceive or are in the early stages of pregnancy to go for regular health checkups. They should not ignore the signs of arthritis and get it treated before it develops into a more severe disease.