Professional Documents
Culture Documents
Pregnancy
andarthritis
This booklet provides information
and answers to your questions
about pregnancy and arthritis.
www.arthritisresearchuk.org
Arthritis Research UK
Pregnancy and arthritis
Whats inside?
2 Pregnancy and arthritis
at a glance
5 Introduction
5 Planning for a baby
Paracetamol
Non-steroidal anti-inflammatory
drugs (NSAIDs)
Corticosteroids (steroids)
Disease-modifying anti-rheumatic
drugs (DMARDs)
Biological therapies
25 Research and
newdevelopments
26 Glossary
28 Where can I find out more?
32 Were here to help
At a glance
Pregnancy and arthritis
Arthritis Research UK
Pregnancy and arthritis
ciclosporin
mycophenolate mofetil
gold injections
cyclophosphamide
methotrexate
leflunomide.
Arthritis Research UK
Pregnancy and arthritis
Introduction
If you have arthritis or a related condition
and youre thinking about having a baby,
you may have concerns about the effect
of the pregnancy on your condition
and the effect of your condition on the
pregnancy and your baby. Because these
conditions are so variable its best to get
advice from your doctor or specialist
nurse before you try for a baby.
The general information in this booklet
applies to most forms of arthritis, but
theres a separate section for people who
have lupus (systemic lupus erythematosus
or SLE), because this disease behaves
differently in pregnancy from other
types of arthritis (see section Lupus (SLE)
andpregnancy).
See Arthritis Research UK booklet
What is arthritis?
Arthritis Research UK
Pregnancy and arthritis
Arthritis Research UK
Pregnancy and arthritis
Osteoarthritis
Most forms of osteoarthritis arent
usually passed on from parent to child.
Otherfactors such as age, joint injury
or being overweight play a more
important part.
One common form of osteoarthritis that
does run strongly in families is nodal
osteoarthritis. This form of arthritis
mainly affects women and causes firm
knobbly swellings on the fingers and
often swelling at the base of the thumb,
just above the wrist. Nodal osteoarthritis
usually doesnt start until women are
intheir 40s or 50s, around the time
ofthemenopause, so you may not
develop itwhile youre of child-bearing
age. Thechance of nodal osteoarthritis
being passed on from mother to daughter
isabout 1 in 2 (50%).
See Arthritis Research UK booklet
Osteoarthritis.
Rheumatoid arthritis
Although several members of the same
family can be affected by rheumatoid
arthritis, the tendency to pass it on from
parent to child isnt very strong. Research
is continuing in this area, but the risk
ofachild inheriting rheumatoid arthritis
from a parent is between 1 in 100 to
1in30 (about 13%) so theyre far more
likely not to get it than to get it.
See Arthritis Research UK booklet
Rheumatoid arthritis.
Ankylosing spondylitis
The chance of a child inheriting
ankylosing spondylitis is estimated
at about 1 in 6 if the parent has the
gene HLA-B27, and about 1 in 10 if not.
However, the way that the condition runs
in families isnt straightforward so its best
to discuss this with your rheumatologist.
When ankylosing spondylitis occurs
inafamily where other members have
it, it tends to be less severe than when
theres no apparent family link.
See Arthritis Research UK booklet
Ankylosing spondylitis.
Psoriatic arthritis
The risk of passing on psoriatic arthritis
toyour child is probably similar to the risk
for rheumatoid arthritis at about 1 in 30,
although the risk of the child developing
psoriasis is higher.
See Arthritis Research UK booklet
Psoriatic arthritis.
Lupus (SLE)
If you have lupus the chances of your
child developing it in later life are about
1 in 100. Because of the way the genes
involved work, theres actually a greater
risk of other relatives developing the
disease for example, 1 in 33 (3%) for
the sister of someone with lupus (the risk
islower for brothers).
See Arthritis Research UK booklet
Lupus (SLE).
9
Arthritis Research UK
Pregnancy and arthritis
Many women
findthat
flare-ups reduce
duringpregnancy.
Its important
tokeep exercising
for as long
aspossible.
12
Arthritis Research UK
Pregnancy and arthritis
Lupus (SLE)
andpregnancy
Will the pregnancy affect
my lupus?
Arthritis Research UK
Pregnancy and arthritis
15
Arthritis Research UK
Pregnancy and arthritis
18
Arthritis Research UK
Pregnancy and arthritis
Drugs, pregnancy
andbreastfeeding
Every parent hopes that theyll have
ahealthy baby. In an ideal world the
process of having children, from
conception to breastfeeding, would
be drug-free because we can never be
100%sure that the drug will be harmless
to the developing child. In fact, most drug
manufacturers and the Arthritis Research
UK drug information leaflets recommend
avoiding drugs during pregnancy or while
breastfeeding but that doesnt mean
the drug will harm your baby. In fact,
this advice is given because theres a lack
of evidence that the drugs are harmful
rather than strong evidence that they
actually cause harm in pregnancy.
In order for the pregnancy to have a
successful outcome for both mother
andbaby, sometimes drugs are essential.
Thefollowing sections provide a
summary of what we know about the
effects of these drugs during pregnancy
and while breastfeeding. In some cases
theres only limited information available,
but we do know that, for most drugs,
many pregnant or breastfeeding women
will take them without any problems.
Westrongly recommend that you discuss
each drug you take with your doctor
either when youre planning a family or
as soon as possible if you unexpectedly
become pregnant.
Paracetamol
We strongly recommend
that you discuss each
drug you take with your
doctor either when
youre planning a family
or as soon as possible
if you unexpectedly
become pregnant.
Non-steroidal anti-inflammatory
drugs (NSAIDs)
Women taking
steroids throughout
pregnancy are advised
to take supplements
of calcium and vitamin
D to help prevent
osteoporosis.
Corticosteroids (steroids)
Arthritis Research UK
Pregnancy and arthritis
Disease-modifying anti-rheumatic
drugs (DMARDs)
Azathioprine
This drug doesnt affect fertility in men
or women. Many women whove taken
azathioprine have gone on to have
normal pregnancies and breastfeed
healthy babies; however, there are
potential risks in pregnancy at high doses
(more than 2 mg/kg) and tiny amounts
of it do appear in breast milk. So if youre
planning a family or become pregnant
while taking azathioprine, you should talk
to your doctor as soon as possible.
See Arthritis Research UK drug
leaflet Azathioprine.
Ciclosporin
Ciclosporin is used widely in people
whove had transplants as well as for
arthritis, and many women who have
used the drug have had successful
Indigestion can be a
problem with NSAIDs
and also in pregnancy.
Antacid medications
usually help, but if its
very troublesome you
should tell your doctor.
Arthritis Research UK
Pregnancy and arthritis
Cyclophosphamide
Cyclophosphamide can reduce fertility
in both men and women, so you may
be advised to bank sperm or have
ovarian tissue stored before you start
treatment with the drug. If possible,
cyclophosphamide should be stopped
at least 3 months before trying for a
baby, and it should be avoided during
pregnancy as its likely to be harmful.
Bottle-feeding is recommended if you
need to take this drug after the baby
isborn.
See Arthritis Research UK drug
leaflet Cyclophosphamide.
Gold injections
Gold injections dont appear to affect
fertility. The drug does cross the placenta
so its not recommended during
pregnancy. However, there have been
noreports of this harming the baby.
Goldis excreted in the breast milk and
may cause a rash and kidney problems in
the baby, so women who wish to continue
with this drug should bottle-feed.
See Arthritis Research UK drug
leaflet Gold by intramuscular injection.
Hydroxychloroquine
This drug is often taken to prevent
malaria as well as for arthritis and
sofarit doesnt appear to increase the
risk ofbirth problems, even at higher
doses. Many women with lupus have
used it successfully during pregnancy
23
Mycophenolate mofetil
You shouldnt take mycophenolate
when youre pregnant, and you
shouldnt become pregnant for at least
6 weeks after you stop taking the drug.
Mycophenolate must not be taken while
youre breastfeeding. If youre planning
a family or if you become pregnant
while taking mycophenolate, you should
discuss this with your doctor as soon
aspossible.
See Arthritis Research UK drug
leaflet Mycophenolate mofetil.
Methotrexate
This drug can cause miscarriages or
conditions such as spina bifida. Reliable
contraception is essential whether youre
male or female. Methotrexate must
not be taken while youre pregnant or
breastfeeding, and it should be stopped
at least 3 months (although some doctors
recommend upto 6 months) before
you try to become pregnant or father
a child. If youre planning a family or
become pregnant while on methotrexate,
youshould speak to your doctor as soon
as possible.
See Arthritis Research UK drug
leaflet Methotrexate.
Penicillamine
Penicillamine isnt generally
recommended and can cause problems
if taken in high doses in early pregnancy;
24
Biological therapies
Arthritis Research UK
Pregnancy and arthritis
Research and
newdevelopments
Exposure to biological therapies and
newer immunosuppressive drugs is
building. For instance, in the UK the
British Society of Rheumatology (BSR)
is gathering information on over 12,000
patients treated with adalimumab,
etanercept and infliximab in a biologics
registry (called the BSRBR) to examine
thesafety of these drugs. Information
from this registry on patients who
continue pregnancy and breastfeeding
while taking these drugs will allow
doctors tobetter determine their
safety in these circumstances. There is,
however, still an urgent need for studies
clarifying the risk of anti-rheumatic drugs
during breastfeeding and in men trying
tofathera child.
Glossary
Arthritis Research UK
Pregnancy and arthritis
27
Antiphospholipid syndrome
Lupus (SLE)
Osteoarthritis
Osteomalacia
Osteoporosis
Psoriatic arthritis
Rheumatoid arthritis
What is arthritis?
Drug leaflets
Adalimumab
28
Therapies
Azathioprine
Certolizumab pegol
Ciclosporin
Arthritis Research UK
Pregnancy and arthritis
Cyclophosphamide
Drugs and arthritis
Etanercept
Gold by intramuscular injection
Hydroxychloroquine
Infliximab
Leflunomide
Local steroid injections
Methotrexate
Mycophenolate
Non-steroidal anti-inflammatory drugs
Rituximab
Steroid tablets
Sulfasalazine
Tocilizumab
Related organisations
The following organisations may
beable to provide additional advice
andinformation:
Arthritis Research UK
PO Box 177
Chesterfield
Derbyshire S41 7TQ
Phone: 0300 790 0400
www.arthritisresearchuk.org
Arthritis Care
18 Stephenson Way
London NW1 2HD
Phone: 020 7380 6500
Helpline: 0808 800 4050
www.arthritiscare.org.uk
Brook
421 Highgate Studios
5379 Highgate Road
London NW5 1TL
Phone: 0207 284 6040
24-hour recorded information line:
0207950 7700
Helpline for under-25s: 0808 802 1234
www.brook.org.uk
Disability, Pregnancy
&ParenthoodInternational
National Centre for Disabled Parents
Unit F9, 8993 Fonthill Road
London N4 3JH
Phone: 0800 018 4730
www.dppi.org.uk
29
30
Arthritis Research UK
Pregnancy and arthritis
Notes
31
Arthritis Research UK
Pregnancy and arthritis
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Registered Charity No 207711
Arthritis Research UK 2011
Published April 2011 2060/PREG/11-1