The single most important piece of advice that we can give about planning a family is to discuss it with your rheumatology team in advance.
AS varies a great deal between one person and another (as can pregnancy!) and, although we will try and provide general information and advice on this page, do bear in mind it is for general information purposes only and is in no way intended to be a substitute for a medical consultation with a qualified professional.
Do not stop taking the medication you have been prescribed for your AS without talking to a member of your rheumatology team.
It's recommended that every woman who wants to have a baby should take a folic acid tablet every day from 3 months before the time of conception until 12 weeks into the pregnancy. Folic acid will reduce the risk of your baby having a defect in the spinal canal (spina bifida).
Fertility and AS
Having AS will not directly affect your ability to conceive. However some medications, including sulfasalazine can cause a fall in sperm count and so can lead to a temporary decrease in male fertility. This effect is reversed when you stop taking the medication.
Do make sure you discuss this issue with your rheumatologist.
Pregnancy and AS
Women with AS generally have healthy babies and they carry them to full term.
Having AS does not have a harmful effect on the course of pregnancy or on the well-being of your unborn child. The rate of miscarriage, stillbirth, and small for gestational age infants among women with AS is similar to that of other healthy women.
Women with AS are not more likely than other healthy women to get pre eclampsia or to go into premature labour.
Your medical team
Many obstetrics services in the UK are now lead by community midwives and women may never meet the obstetrician in charge of the service. We do recommend that you explain to your midwife early on in your pregnancy that you have AS and would like to see the obstetrician to develop a care plan tailored to your needs.
Your midwife will also be able to make sure you see the anaesthetist well in advance of your labour to discuss any concerns you may have and to ensure they fully understand your AS and how it affects you.
Exercising during pregnancy
It's important for you to keep exercising for as long as possible during your pregnancy. This will help both with your general health and with your AS. As your pregnancy advances and you gain weight you may find it easier to exercise in the swimming pool where the water will help to support your weight.
AS symptoms during pregnancy
There is no pattern to women's AS symptoms during pregnancy. Some find their symptoms improve, some find they stay more or less the same and others find they get worse.
Medications and pregnancy
The ideal situation is that women do not take any medication while they are pregnant and breast feeding. However, the reality is that you may have active AS at some point in your pregnancy and need pain relief. It will be important to discuss this with your rheumatology team, ideally in advance, so that you know what options are going to be available to you. This will avoid situations where your AS flares up and you don't know what medications you can and cannot safely use.
In January 2016 The British Society for Rheumatology published new guidelines, aimed at rheumatologists, on prescribing anti rheumatic drugs in pregnancy.
Non steroidal anti inflammatory drugs (NSAIDs)
NSAIDs are now not recommended during pregnancy. It is especially important that you avoid taking NSAIDs during the final trimester of your pregnancy. Most experts agree that, if NSAIDs are used in pregnancy, they should be stopped by week 32.
If you are having pain in one or two specific joints you might find a local steroid injection into the joint useful. Single injections of steroid should not affect pregnancy. However, do make sure your doctor knows you are pregnant before having a local steroid injection.
If you are taking oral steroids (prednisolone) and you are planning a family you should discuss this with your doctor beforehand. If you find you are pregnant and are on steroids, do not stop them, but discuss things with your GP or rheumatologist.
Never stop steroids abruptly. The new BSR guidelines state that 'Prednisolone is compatible with each trimester of pregnancy'. This means that you and your rheumatologist might decide it's best for you to stay on prednisolone during your pregnancy.
Disease modifying anti rheumatic drugs (DMARDs)
Methotrexate should not be taken during conception or pregnancy. Both men and women using these drugs should take contraceptive precautions. After stopping methotrexate, men and women should continue using contraception for at least 3 months before trying to get pregnant..
Sulfasalazine is considered safe in pregnancy, however, like all other medications, this may be stopped during your pregnancy. It will be important to discuss your personal situation with your rheumatologist before becoming pregnant. This advice applies to both men and women.
Anti TNF therapy
Anti TNF should not be routinely used during pregnancy. If you are on anti TNF therapy it is very important that you discuss your options with your rheumatology team before becoming pregnant. You may well decide that you do not want or need to take anti TNF during pregnancy.
Current advice is that if anti TNF is needed during pregnancy:
- adalimumab (Humira) and etanercept (Enbrel) should be avoided during the third trimester. This is due to a theoretical increased infection risk in new born babies.
- infliximab (Remicade, Remsima and Inflectra) should be stopped at 16 weeks. This is again due to a theoretical increased infection risk in new born babies.
If these drugs are continued later in pregnancy to treat active disease then live vaccines should be avoided in the infant until seven months of age.
Based on limited evidence certolizumab pegol Cimzia) is compatible with all three trimesters of pregnancy and has reduced placental transfer compared with other TNFi.
You should have a normal labour.
Sacroiliac joint or hip problems, even including a total hip replacement, should not necessarily stop you from giving birth naturally. There are different positions that you can use which would make you more comfortable. Talk about different positions to your midwife.
It's a good idea to make an appointment to talk to your midwife (or ideally an anaesthetist) in advance about pain relief during your labour. Lots of women opt for an epidural during labour. Occasionally this may be technically more difficult to administer. Your midwife or anaesthetist will be able to tell you about other options that are available.
We do know that caesareans do tend to be carried out more frequently among women with AS. Sometimes this is because obstetricians prefer to do an elective caesarean section in women with inflammatory joint disease.
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