What to Know About Rheumatic Disease in Pregnancy

Having a baby is a big change for anyone, but even more so when you live with a rheumatic disease. The demands of being pregnant can affect the course of your illness. And the disease itself, plus any drugs you take to manage it, may impact your baby’s health.

Most women with a rheumatic disease can have a healthy pregnancy. But prenatal planning and close attention to your health while pregnant are vital. Keep reading to learn about rheumatic illness in pregnancy and what you can do to keep yourself and your baby healthy.

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What Is a Rheumatic Disease?

An autoimmune disease is when your immune system mistakes your healthy cells and tissues for harmful ones. As a result, your body makes antibodies that attack healthy parts of your body. Autoimmune disease can affect any part of your body.

Rheumatic disease includes autoimmune diseases and those in which the body becomes inflamed. They can affect your:

  • Bones.
  • Connective tissues.
  • Joints.
  • Muscles.
  • Other organs.

They’re life-long health issues that may worsen over time and tend to affect more women than men. They often strike while women are young adults and thinking about having kids.

These are common rheumatic diseases and their effects:

  • Ankylosing spondylitis is a type of arthritis that attacks your spine and other joints.
  • Antiphospholipid syndrome causes blood clots to form in arteries and veins. It also heightens the risk of losing a pregnancy.
  • Myositis attacks healthy muscles.
  • Psoriatic arthritis is scaly, flaky skin patches that occur with arthritis.
  • Rheumatoid arthritis causes pain and swelling in your joints.
  • Scleroderma causes thick or tight skin and scarring in many areas of the body.
  • Systemic lupus erythematosus, also called SLE or lupus, affects tissues and organs, causing a lot of inflamed areas all over the body.
  • Vasculitis inflames your blood vessels.

Rheumatic illnesses cause inflamed body parts, pain, and fatigue that doesn’t go away. They can also affect how some of your organs work. Most people need medicine to manage the disease and control symptoms.

Rheumatic Disease in Pregnancy

Being pregnant puts even a healthy body under a lot of stress. Every part of your body works harder to support you and your growing baby from conception until delivery. Many people with rheumatic diseases can have healthy pregnancies. However, having a rheumatic illness can lead to unique issues while pregnant, like:

  • A low-birth-weight baby.
  • Blood clots.
  • Early or late miscarriage.
  • Delivery before full term.
  • High blood pressure, including preeclampsia — severe, life-threatening high blood pressure that can damage your organs.
  • Problems with your kidney function.
  • Pulmonary hypertension — a dangerous type of high blood pressure in your lungs.
  • Seizures.
  • In rare cases, damage to your baby’s heart.

Some rheumatic diseases carry higher risks to pregnant people than others. And your risk depends on other health factors too. Having any of these health issues makes being pregnant high-risk:

  • Age Over 40.
  • Blood clots previously.
  • Carrying more than one baby.
  • Certain antibodies in your blood (SSA, SSB from lupus, and aPL, from antiphospholipid syndrome).
  • Health issues while pregnant before.
  • History of or current kidney, lung, or heart disease.
  • IVF.
  • Rheumatic illness that flares while pregnant.

For some rheumatic diseases, being pregnant might affect their course. Pregnant people with lupus, for instance, are often more likely to have issues, especially if the lupus is not well-controlled at the time of conception. And flare-ups are harder to manage because many drugs you’d take for lupus may harm the baby.

Other health issues, like rheumatoid arthritis, tend to improve while pregnant so you might need less medicine. But it might flare up after you deliver your baby.

Planning a Pregnancy with a Rheumatic Disease

If you’re not planning for a baby soon and wish to delay or avoid pregnancy, doctors suggest using birth control to prevent an unplanned, high-risk pregnancy. Your doctor can suggest the best type based on your health and family planning goals.

If you are thinking about having kids, watch your health closely before, during, and after pregnancy to reduce the risk of health issues. Most people with rheumatic disease can and do have healthy babies. But doctors suggest that your illness is well controlled for at least three to six months before getting pregnant.

Before getting pregnant

Before trying to conceive, strongly consider a visit your obstetrician and rheumatologist. They can assess your health and family goals and help you plan to get pregnant. Preconception counseling allows your doctors to:

  • Review the medicine you take and find new options for any that are not compatible with pregnancy. Your illness may respond better to some drugs than others, so it may take time to find the right ones.
  • Provide any other guidance to help you get your rheumatic disease under control. People with active disease have a far greater chance of health issues.
  • Ensure any other health issues, like high blood sugar or high blood pressure, are well-controlled before getting pregnant. These will put you at a higher risk of health issues while pregnant.
  • Help you get to a healthy weight. Having a higher body mass index raises the risk of health issues.
  • Assess your diet and lifestyle. Eating right, taking prenatal vitamins, getting exercise often, and not smoking are vital for a healthy baby. A healthy diet and lifestyle also make living with your rheumatic disease easier.
  • Help you know the risks of being pregnant so you can prepare. It may be high or low risk for you and your baby based on your illness and other health issues.

While pregnant

When you’re pregnant and have a rheumatic illness, staying in close contact with your health care team is vital. Make sure you attend all prenatal visits and report any odd symptoms or changes in your rheumatic disease to your doctor.

You may need frequent check-ups to test your blood pressure and how your heart and kidneys are working. And your doctor may do more ultrasounds or other tests to check that your baby is growing normally. You may also need new medicines to manage your health and reduce health issues.

If you have health issues, you may need bed rest or to stay in the hospital to keep you both safe. In some cases, your doctor might suggest having your baby early.

After delivery

During the days and weeks after having a baby, your body needs time to recover. You’ll feel tired and sore from labor and delivery; if you have a c-section, you’ll need to heal from surgery. That, coupled with a lack of sleep from an always-hungry newborn, can take a toll on any new parent.

Living with a rheumatic illness adds hardship to the postpartum period. If your illness waned while pregnant, it might flare after delivery.

It’s vital to plan ways to manage your illness if it worsens. Ideally, that should include having someone help care for your baby and you if needed. You may need extra doctor visits or just quiet time to rest.

Discuss your medicine with your doctor if you plan to nurse your baby. Just as while you were pregnant, some are unsafe while breastfeeding.

Having a rheumatic illness does not mean you can’t think about getting pregnant. But there’s a lot to talk about and plan for.

Working with rheumatology and reproductive experts can ease the process. They can guide and support you so you have a safe, healthy time before, during, and after your pregnancy.

To learn about the UPMC Women’s and Reproductive Health Rheumatology Clinic, call 412-647-6700.

Sources

American College of Rheumatology. Pregnancy & Rheumatic Disease. LINK

About UPMC

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