Pregnancy & Rheumatic Disease

May 1, 2023 | Rheumatic Disease


Thoughts of pregnancy and starting a family can be quite frightening while trying to keep your rheumatic disease under control. Concerns about complications during the pregnancy or harm to the baby can make family planning and pregnancy with a rheumatic disease feel quite overwhelming. For these reasons and more, communicating with your rheumatology care team and ensuring that your rheumatologist and obstetrician are in communication with one another is key. Here are some other tips to help you navigate this journey:

Start early

Discuss your fertility goals with your rheumatology care team as early as possible and update them as your goals evolve. Your team can help plan for your pregnancy, specifically gauging how active your disease is and when would be the safest time to attempt conception. If you’re looking to become pregnant, make an appointment with an obstetrician in addition to an appointment with your rheumatologist. Discuss your family planning goals, review the medications you are taking, and discuss which medications will need to be stopped before pregnancy and which can be continued with all your doctors.

Learn from others’ experiences

To help you feel more comfortable, take time to learn from others who have gone through a similar experience. Most people find information online or speak to friends and family with experience. Simple Tasks can also be a reliable and trusted initial resource for information. [Be sure to also check out our list of Patient Resources – developed in collaboration with rheumatology healthcare professionals, patients and reproductive health experts – which has links to trusted information and resources on family planning, pregnancy and parenting considerations for those living with a rheumatic disease.] Just remember, no two people are the same, but learning from others can help you manage your expectations and realize your family goals.

Clarify concerns regarding medications

Your obstetrician can clarify which medications are safe to continue during pregnancy and which must be stopped. However, you should also plan to discuss this with your rheumatologist.  It is important to understand the risks related to these medications both to you and your baby. Oftentimes, your healthcare team must change your medications several months prior to pregnancy to medications that are pregnancy compatible. Patients should be aware that their rheumatologist may suggest they change to an alternative medication and then be watched for both efficacy and tolerance of the new medication before trying to conceive. Keep in mind that there are situations where the benefits of medication may outweigh potential risks to you and/or your baby and this should be discussed with your rheumatologist and obstetrician.

Medication concerns may also apply to breastfeeding. Consider asking your rheumatologist if breastfeeding is recommended in your case. Some patients would like to breastfeed, but certain medications cannot be continued while breastfeeding. In other situations, the stress of breastfeeding can trigger disease flare-ups. All possibilities should be discussed with your health care providers so you can make the decision that is best for you and your baby.

Some patients with a rheumatic disease have an increased risk for clotting and may require anticoagulation therapy (blood thinners). Talk with your providers to ensure adequate screening and appropriate treatments are in place.

Consider the impact of flare ups

Symptoms of pregnancy can sometimes mimic a flare of rheumatic disease. Having this insight can prevent confusion and enhance self-awareness can help you recognize the difference. Be sure to talk with your rheumatologist about what you should be looking for in a flare up during your pregnancy.

Think about your birthing plan early

Will you need to be induced? Is your team planning for a vaginal delivery or cesarean section? While these answers are not typically available until later in pregnancy, planning early provides a sense of comfort in knowing the likely outcomes of the pregnancy.

Plan for regular pre- and post-partum visits with your rheumatology care team

How often do you need to be seen by your rheumatologist? Some providers request their patients be seen every 4-6 weeks during pregnancy. Plan so you’re not scrambling to get an appointment later.

If you have a rheumatic disease, a safe and successful pregnancy is possible. Plan to work closely with your rheumatologist to discuss your reproductive health goals and disease management strategies that can reduce your health risks.  Also, plan to stay tuned this September for even more trusted and accessible resources for people with rheumatic disease during pregnancy, planning and early parenting.

Vaneet Sandhu, MD

About the Author

Vaneet Sandhu, MD

Vaneet Sandhu, MD, is a practicing rheumatologist and associate professor of medicine as well as the associate program director of the rheumatology fellowship program at Loma Linda University Medical Center. Dr. Sandhu is also a member of the American College of Rheumatology’s Communications and Marketing Committee. Dr. Sandhu can be found on Twitter at @vksandhumd.

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