Planning for a baby
一点也不早开始对话机智h your doctor so that you can get on the right treatment plan.
If you have a type of inflammatory arthritis you may be referred to an obstetric rheumatology clinic. They can advise on everything from fertility, to the pregnancy and the medications available. This may be something your local hospital offers or you may be referred to a nearby specialist centre.
If you’re already on a pregnancy friendly drug, you won’t have to worry about coming off it or switching medications when you decide to start trying for a baby.
But we know that it’s not always possible to plan ahead. In which case, it’s important to let your rheumatology team know as soon you become pregnant. They can check everything is fine and make sure you’re on the right medication.
What are the chances of my child having arthritis?
There are many other factors involved in the development of arthritis, not just the genes inherited from parents.
Most forms of arthritis do run in families to some extent. But you shouldn’t worry about this, as in the vast majority of cases the chances of passing it on to your children are low.
The best time to have a baby is when it feels right for you.
It’s better to try for a baby when your condition isn’t very active, as this will improve the chances of having a successful pregnancy for both you and your baby.
If you’re struggling to get pregnant after a year of trying, you should seek advice from a fertility expert. If you’re over 36 years old, or already know you may have fertility problems, you should seek advice sooner.
It may take slightly longer for women with arthritis to become pregnant, so you might want to bear this in mind.
Information related to planning for a baby
Sex and relationships
Arthritis can affect sex and your relationships, this section looks at some of the common challenges and ways to manage them.
Rheumatology nurse specialist
A rheumatology nurse specialist has expert experience in looking after the needs of people with arthritis and related conditions.
What if I have fertility problems?
Your arthritis is unlikely to affect your fertility, this is your ability to get pregnant. But fertility does decrease with age, so some women will need fertility treatments, such as egg boosting, intrauterine insemination (IUI) or in vitro fertilisation (IVF).
Most women with arthritis are fine to have fertility treatments if their condition is under control.
If your condition is not currently under control, or you feel that now is not the right time to have a baby, you have the option of freezing your embryos or eggs to use at a later date.
Discuss any plans for fertility treatment with yourrheumatologist。他们可以向您的生育顾问提供具体的建议，以与您的治疗建议进行任何建议调整，并考虑转介给产科风湿病学诊所以怀孕前咨询。
Boosting egg production is a common fertility treatment and can be done on its own, or as part of another assistive reproductive technique.
But the medication used to boost egg production can lead to an increased risk of flares in women with狼疮and can also increase the risk of blood clots. Because of this, women with lupus should be monitored more closely. And those who test positive for antiphospholipid antibodies may need to be on a blood thinner such as heparin.
IUI is a fertility treatment where sperm is inserted directly into the womb. In some cases, you may need to take medication to boost your egg supply to increase the chances of success.
During IVF you’ll receive medication to boost your egg supply. The eggs are then extracted and mixed with sperm to fertilise them. Once the eggs have been fertilised, and become embryos, these will be placed back into the womb.
Will the pregnancy affect my arthritis?
All women get aches and pains, particularly backache, during pregnancy. As the baby grows, it could put more strain on some of your joints. Especially on your hips and knees.
Experts used to think that almost all women withrheumatoid arthritisgot better during pregnancy. But recent studies have shown that while pregnancy can be beneficial, it’s not always the case.
For rheumatoid arthritis it’s estimated that three in five women will notice some form of improvement, but that almost half will have a flare-up after giving birth.
虽然不是很上尽可能多的信息ts of pregnancy on other rheumatic conditions, it’s clear that they all need to be managed appropriately during pregnancy to help prevent flares during and after the birth.
Should I take drugs during pregnancy?
Historically, women were told that they should come off all arthritis medications before pregnancy. But now we know that many drugs can be taken safely.
Keeping your condition in check is really important if you’re thinking of trying for a baby. So, you shouldn’t just stop taking prescribed drugs without talking to your doctor first.
By continuing anti-rheumatic drugs that are safe in pregnancy you will make it more likely that your condition will remain under control during the pregnancy. This will reduce the chances of any complications during the pregnancy and will make flares less likely immediately after the birth.
It’s really important to discuss the medications available with your doctor, so that you can make an informed decision and get on the treatment plan that’s right for you.
Check out the drugs section of this page for more information on drugs that are safe in pregnancy.
Can I take supplements?
Folic acid supplements are important for the health of your baby. You should start taking them roughly three months before pregnancy and continue for another three months into the pregnancy.
环磷酰胺is the only anti-rheumatic drug which we know for certain should not be taken by men wanting to try for a baby.
However, there are also drugs that we don’t have a lot of information on, so it’s important to discuss these with your doctor.
For more information on drugs and pregnancy go to the drugs section of this page.
Scans and tests
Blood and urine tests will be done regularly throughout your pregnancy, especially if you’re feeling unwell.
It's recommended that all pregnant women have at least two ultrasound scans. One between 8 to 14 weeks and one between 18 to 21 weeks. The first scan is used to check the pregnancy dates, while the second is used to check that the baby is healthy.
Further scans are sometimes needed in people with arthritis. For example, you might need an extra scan if you’ve taken certain drugs during the pregnancy that require further monitoring.
For instance, the baby could then develop a rash or abnormal blood tests after birth. But these will clear up once the mother’s antibodies are gone from the baby’s blood. This can take anything from a couple of weeks to a few months.
In rare cases, the antibodies affect the baby’s heart, causing it to beat slowly. If you have these antibodies, you should tell your obstetrician, as your baby’s heartbeat will need extra monitoring in the womb.
Test for antiphospholipid antibodies
You may need a blood test to check for antiphospholipid antibodies, as they can interfere with the body’s ability to regulate blood clotting. These antibodies are present in women withantiphospholipid syndrome（AP）和大约一半的患者狼疮。
Will I be able to do my exercises?
It’s important to keep your arthritis under control so that you can keep exercising throughout your pregnancy.
You should also try to do some strength training exercises a couple of times a week. This could be with weights, but even daily activities like carrying some shopping bags can help.
Don't be scared of exercising if you’re pregnant. If you’re already active keep going. There’s no need to cut back on the amount of exercise you do.
You might even want to think about joining a prenatal or postnatal exercise class. But make sure you tell the instructor that you have arthritis.
Labour and the delivery
Your arthritis shouldn’t usually affect the delivery. Even if you’ve had ahip replacement, you should still be able to give birth through your vagina.
你的助产士通常可以建议更舒适positions if your arthritis is causing you pain.
Labour is known to be painful, so it can be helpful to know about the pain relief options available.
Pain relief during labour
Gas and air
This is a combination of oxygen and nitrous oxide. Gas and air can help reduce some of the pain during labour. It’s easy to control as you breathe it in through a mouthpiece that you hold yourself.
Epidurals are a special type of local anaesthetic given into the back which, for most women, give complete pain relief. While usually a straightforward procedure, conditions likeankylosing spondylitiscan make it more difficult. In these scenarios an anaesthetist can meet with you first to discuss the options.
Some women choose to have a water birth as it can help them relax during labour and make the contractions seem less painful.
Birth pools can be set up in your home, but your maternity ward may also have access to one.
TENS (transcutaneous electrical nerve stimulation)
TENS machines have small pads which are taped to your back and connected to a small battery-operated machine which produces a small current.
They have been shown to reduce some of the lower back pain that some women experience during the early stages of labour. But TENS machines aren’t effective during the later stages when the contractions become longer and more frequent.
If you wish to use a TENS machine speak to your midwife so that they can show you how it works.
Learning how to relax can help you manage the pain of labour. You might even want to try an antenatal class, such as hypnobirthing. Antenatal classes will teach you a variety of techniques and skills that’ll help you prepare for labour and the birth.
Where can I give birth?
Where you can give birth will depend on your condition and your specific needs. While some women choose to have their baby in a hospital, others prefer a midwifery unit or even the comfort of their own homes.
It’s important to choose a location that you feel comfortable in. But your arthritis could make your birth a slightly higher risk than others, so it’s important to discuss your chosen location with your maternity team. They’ll be able to address any worries or concerns and can help you create a birth plan.
Your birth plan should be flexible to account for any possible changes in circumstances that arise during the birth. The maternity team can advise you on your options if specific circumstances arise.
Caesareans are major operations, so they’ll only be done if it’s thought to be the best thing for you and your baby. If you have a planned caesarean section you should discuss with yourrheumatologistwhether to stop yourdmardsbefore surgery.
Coping with the demands of a small baby is exhausting for any new mother. And if you have arthritis the stresses can be much greater. You might also find that your arthritis flares up again in the weeks after the birth. But the risk of this is reduced if you continue taking pregnancy safe treatment during pregnancy or breastfeeding.
但是，如果这些症状持续超过几周或以后开始，则可能会有产后抑郁症。这会影响分娩后一年中十分之一的女性中的十分之一以上 - 您可能会感到难过，难以入睡，与您的婴儿建立困难或有令人恐惧的想法。如果您有这种感觉，请寻求帮助很重要。
Your health visitor and GP can help you access any support or treatment you might need.
There are a wide range of services and support available for new parents. You can find out more information about what’s available onNHS services and support for parents。
哺乳is good for both you and your baby. And the longer you breastfeed for the longer these benefits last. But any amount of breastfeeding is beneficial.
In the first few feeds you’ll produce a thick yellowish fluid called colostrum. This is packed full of antibodies that will boost your baby’s immune system and protect them from harmful bacteria and viruses.
But we understand that breastfeeding isn’t for everyone, and for some women it can be very difficult. It’s important to make the decision that’s right for you. And if you have any concerns or worries, it’s important you have a chat with your doctor, midwife or health visitor.
You don’t need to make the final decision until the baby is born, but it’s never too early to start thinking about it. If you choose to breastfeed, your doctors will make sure you’re on drugs that won’t affect your baby.
Some women choose to combine breastfeeding with formula or expressing. This can take some of the pressure off breastfeeding as it means that friends or family members can help with feeding.
Restarting your medication
If you’ve come off any medications before the pregnancy, such as甲氨蝶呤, your doctors will usually recommend going straight back onto them once you’ve finished breastfeeding. This is because the sooner you can get back onto your medication, the lower the risk of having a flare.
有些药物可以在母乳喂养期间重新启动，因此您应该与您的rheumatologistexactly when you can restart your medication.
If you flare before your drugs have started working your doctor might suggest a short course of steroids. If only one or two joints are painful your doctor might suggest a类固醇注射instead.理疗can also be helpful during this time.
If you’re pregnant or planning a pregnancy, it’s important to discuss your treatment plan with your doctor.
This section goes through the most commonly used drugs for arthritis. The information has been taken from the British Society for Rheumatology (BSR) and updated with more recent guidance from the American College of Rheumatology (ACR) to highlight which drugs are safe to take.
We have produced two tables which summarise which drugs are safe to take in pregnancy:
The information in these tables and in this section is meant to be used as a rough guide to aid in deciding the best medication route for you. Please discuss this drug information with your doctor, and don’t stop taking your medication without speaking with them first.
For more information on each of these drugs you can visit the我们网站的毒品部分并选择您希望了解更多有关的药物。
Paracetamol is safe to use throughout pregnancy. But it’s usually advised to only use it as and when you need it, as continuous use may increase the risk of childhood asthma.
Codeine should be fine to take throughout the pregnancy, but caution is advised when breastfeeding as it could affect the baby.
There aren’t many studies that have looked into the safety of tramadol, but it should be OK to take during pregnancy and on a short-term basis when breastfeeding.
There isn’t much data on paracetamol, codeine or tramadol use in men trying for a baby. But it’s unlikely to be harmful as they are all fine for women to take when trying for a baby.
Other long-term pain treatments
Amitriptylineis fine to take throughout pregnancy and should also be fine to take at a low dose during breastfeeding. There aren’t any studies on how it could affect a man wanting to try for a baby. But as it’s fine for the mother to take, it should also be safe for a man wanting to father a child.
There is no data on the use of gabapentin or pregabalin throughout pregnancy or breastfeeding. So, these drugs should be avoided for the time being, until there’s more information available.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDsincludeibuprofen, naproxen, diclofenac and indomethacin. Some studies suggest that taking NSAIDs in the first three months of pregnancy may increase the risk of miscarriage. As such, BSR guidelines advise cautious use of these drugs in early pregnancy. The guidelines also recommend stopping NSAIDs completely after 32 weeks of pregnancy.
A common problem with NSAIDs is indigestion, which is also common during pregnancy. Antacid medication usually helps, but if it’s very troublesome you should tell your doctor.
Steroid tabletscan be taken during pregnancy but it’s important you discuss what you’re taking with your doctor.
If you’ve been on high doses of steroids for a long time you may be given an extra boost of steroids to help your body cope with the stress of labour.
Prednisolone is safe to take during pregnancy and breastfeeding. Men are also fine to take it when trying for a baby.
Steroids, particularly if taken for a long time, or at high doses, can increase the risk of some pregnancy complications like gestational diabetes. So, your doctor will try to keep you on the lowest possible dose for the shortest possible time.
Disease-modifying anti-rheumatic drugs (DMARDs)
羟氯喹通常是采取预防malaria as well as to treat arthritis and狼疮。It can be taken during pregnancy and while breastfeeding. A study showed that women with lupus who continued taking this drug during pregnancy were able to control their condition much better than those who stopped.
Methotrexateshould be stopped three months before you become pregnant. If you become pregnant while taking methotrexate or if you’ve had less than a three-month break from the drug, it’s important you speak to your doctor as soon as possible. They might have to conduct additional baby scans to make sure everything is OK. You’ll also be prescribed a higher dose of folic acid (5mg a day) to take throughout the pregnancy.
It used to be recommended that men stop methotrexate three months before trying for a baby, but research now shows it’s fine to continue.
Women can continue taking磺胺嗪尝试婴儿和怀孕期间。您需要每天服用5mg的叶酸片，这需要由您的医生开处方。如果婴儿健康，母乳喂养也应该很好，但是如果婴儿为时过早，您应该谨慎。
Sulfasalazine may affect sperm count, but this side effect is reversible. Current guidelines say that it’s not necessary for men to stop taking sulfasalazine before trying to conceive. If you’ve been trying to father a child for a year or more while on sulfasalazine, you should discuss this with your doctor and arrange to see a fertility specialist to rule out other issues.
Leflunomideshould not be taken if pregnant or breastfeeding. If you’re a woman considering pregnancy, you should discuss stopping with your doctor. You may need a washout treatment to help remove it from your body more quickly. After this you’ll be started on a drug that can be taken safely during pregnancy.
Based on very limited research, men should be fine to take leflunomide.
Azathioprinecan be taken in pregnancy and while breastfeeding, but you may need to be on a lower dose.
Ciclosporin and tacrolimus
Ciclosporinand tacrolimus can be taken in pregnancy. But it’s likely you’ll be closely monitored to make sure your blood sugar levels, blood pressure, kidney function and drug levels are all OK.
环磷酰胺can affect fertility and shouldn’t be taken if planning a pregnancy. Before starting this drug, it's important to tell your doctor if you want to have children. You should discuss with your doctor whether to have some sperm stored or given medication to protect your ovaries before treatment is started.
环磷酰胺is only considered during pregnancy if your condition becomes life threatening.
Based on very limited research, men should be OK to take mycophenolate mofetil.
Intravenous immunoglobulinsare fine to take throughout pregnancy and breastfeeding.
The data is limited for men wanting to try for a baby. But because it’s not harmful to pregnant women, it’s unlikely to be harmful to men hoping to father a child.
BSR guidelines advise that etanercept and adalimumab should be avoided during the last three months of pregnancy, and that infliximab should be stopped at 16 weeks, for the baby to be drug-free at birth and able to have a normal vaccination schedule.
Increasing evidence also shows that golimumab can be taken safely in the first six months of pregnancy and then stopped in the last three months so the baby can have a normal vaccination schedule.
The main concern with many biologics is that they can pass to the baby in the later stages of pregnancy. So, any live vaccines would need to be avoided until the drugs have left the baby’s system.
If your doctor is concerned about you flaring, then the drugs can be continued throughout the entire pregnancy, but newborn babies should not be given live vaccines until they are at least seven months old. This would include vaccines such as the rotavirus vaccine or BCG.
只有少量的certolizumab pegol传递on from mother to baby. So, this drug can be taken safely during the whole length of the pregnancy.
You should be OK to breastfeed on all anti-TNFs but the research can be limited so it’s important to discuss this with your doctor.
At the moment there is limited data on all of these drugs, and they are generally avoided during pregnancy. However, if your condition has been difficult to control with other drugs and is well-controlled on one of these, you should discuss with your doctor the risks and benefits of continuing them in pregnancy to keep your condition under control.
It’s generally recommended that rituximab should be stopped six months before pregnancy. However, if you accidentally continue taking any of the drugs in this group of biologics in early pregnancy, it’s unlikely to be harmful to your baby.
There is limited research on breastfeeding for this group of drugs, so discuss this with your doctor.
Based on limited evidence, rituximab should be fine to take by men wanting to try for a baby. There is no data on any of the other biologics in this group, but they’re also unlikely to be harmful to men.
Practical tips from mothers with arthritis
We asked mothers with arthritis what their top tips were, they said:
- Get a baby chair or rocker. They help me comfort my baby without hurting my arms and back.
- Try to get a 360 degree car seat, these rotate so that you can easily strap the little one in, they are a massive help.
- Invest in an easy to put on baby sling so that you’ve not got to carry your baby in your arms all the time.
- Buy a cot which you can easily adjust the height of, so you don’t have to lean over too far.
- Try to find a comfortable chair for nursing and soothing your baby.
- Find simple ‘pull on’ baby clothes. Also see if you can get some baby grows with zips instead of poppers.
- Before you buy a pushchair make sure you can easily put it up and take it down. The ones with controls by the feet might be easier to use.
- Child safety cupboard locks that stop toddlers from getting in can be difficult to unlock if you’ve got arthritis in your hands. But there are alternatives, magnetic locks which don’t require you to manoeuvre your hand in are worth a try.
- See if you can get a stairgate design which is easy to use.
Making tasks easier
- Try to have a birth plan and an alternative for if plan A doesn’t work out. Also plan for when the baby’s come. These things do come naturally, but I think it helps to be a little more prepared.
- Find out if you are eligible for a disabled parking badge - this might make you more able to get out and about when struggling with your own mobility and a new baby.
- I found stairs a challenge so made sure I had two baby change stations. One upstairs and one downstairs.
- Place a stool or seat in the bathroom so that when bathing your baby, you’re not constantly leaning into the bath.
- Think about where you position things. A baby bath for example is mobile, I like to put mine on the kitchen counter, saves me from leaning over too much.
Talking to others
- If you want to go to a baby group but are feeling worried, contact the leader and explain your situation. Baby classes are often conducted on the floor, so don’t feel embarrassed to ask for a chair or table.
- Baby swimming classes can be a great way to bond with the little one and spend time with other parents. The warm water is also very soothing on aching joints.
- Tell friends and family what you’re going through and ask for help if you need it, especially if you’re having a flare. Invite people over to help with the baby so you can have a break.
- Once you go back to work, see if your employer can offer extra support. Mine allowed me to start work slightly later and work my hours more flexibly.
- Try to get out and about as much as possible. Walking the dog and keeping active was the best thing for me, both during and after the pregnancy.
- Remind yourself – if this medication doesn't work, another will. There will be better days.
- Keep a gratitude journal for each day, even if it's just something small like 'had a lovely cuppa' or 'had a relaxing shower' it may help you focus on something other than your condition.
- Remember your baby loves you no matter what your ability, you are their world.
Research and new developments
Since 2001, the British Society for Rheumatology has been monitoring the long-term safety of biologics prescribed to people with rheumatoid arthritis in the UK, including drugs taken before and during pregnancy. This is called the British Society for Rheumatology Biologics Register - Rheumatoid Arthritis (BSRBR-RA). There are over 20,000 patients on the register, and the 15 year update identified many papers that had been published using the data, including those on the exposure to anti-TNF drugs in pregnancy. The study aims to continue collecting data until 2028, to create a rich database to better-inform conclusions on the long-term safety of the biologic treatments.
Versus Arthritis is supporting research into the use of怀孕期间补充维生素D。Findings from a study funded by Versus Arthritis were published in The Lancet in 2016, which found that babies born during winter months to mothers who had taken the vitamin D supplement had greater bone mass than babies born to mothers who took the placebo. A follow-up trial is underway, which aims to test whether this improved bone mass from vitamin D supplements continues into childhood.
It was the best feeling when Elfie finally arrived. While it didn’t quite go to plan, I wouldn’t go back and do anything differently.
Even though I was on my meds, I did flare a little when I was seven months pregnant. I recognised the signs early and got some steroids from my doctor. I did panic though, as I didn’t want the flare to dictate whether I could have Elfie as a home birth.
I was 10 days overdue and was beginning to worry they might have to induce me, so I walked our dog four times a day to try to get everything moving. I got funny looks on the moors. You could see people thinking “she's too far pregnant to be walking up here on her own”. But being active really made a difference.
I breastfed for about six months. There's so much direction towards breastfeeding, but I think if you give it a go and you're struggling, you should do what’s right for you.
Once the infection cleared up, it was a couple of weeks before I could restart the drugs. It was challenging, but I think you need to remind yourself to be positive. Nothing is impossible and you can do this.
It’s going to be difficult, but if you plan ahead, make informed decisions and do what’s right for you, you’ll be great.
My final piece of advice comes from an incident with a pooey nappy. Don’t ever launch a pooey nappy out the window, no matter how bad it smells, even if you think you can land it in a bin. You just never know if a neighbour might be popping round to walk the dog.