Making the choice to have a baby can be complicated for any prospective parent. When you have an autoimmune disease, that decision can seem even more complex. You may wonder how pregnancy will impact your disease, and whether your disease will affect your baby.
To help women and their partners sort through these issues, we spoke with three doctors at Virginia Mason Medical Center who specialize in inflammatory bowel diseases (IBD), lupus, multiple sclerosis (MS) and rheumatoid arthritis (RA). These four autoimmune diseases typically affect women during their childbearing ages. Virginia Mason physicians Dr. James Lord, Dr. Lucas McCarthy and Dr. Vivian Stone shared their expertise on how women can plan ahead for healthy pregnancies and what they can expect along the way.
The good news? “Many patients with autoimmune conditions have safe, successful pregnancies,” Dr. Stone says. But it’s important to start talking with your doctor well ahead of conceiving so you can be prepared.
Read on for seven things women with IBD, lupus, MS or RA should consider when thinking about becoming pregnant.
1. Get your disease in check.
Having a baby when you have these diseases is perfectly safe — but it’s best to have your disease well controlled first, according to Drs. Lord, McCarthy and Stone.
Discuss your family planning with your provider well before getting pregnant so you have plenty of time to tune up your medications and take additional steps to keep your disease in check. Your doctor will create an action plan that’s tailored to you, which may include changing what you’re taking or stopping medication altogether.
“In general, uncontrolled inflammation is worse for a baby than the medications used to prevent it,” says Dr. Lord, a gastroenterologist who is also a principal investigator at Benaroya Research Institute at Virginia Mason.
Your doctor may suggest additional preparation. For example, Dr. Lord’s clinic recommends that before women with IBD try to conceive, they have a procedure called a restaging colposcopy to confirm that there is no active disease.
2. Know that your health is vital for your baby’s health.
Doctors want both mom and baby to be healthy throughout pregnancy and birth. It may seem counterintuitive, but continuing medication during pregnancy can keep your autoimmune disease quiet and your body in top shape for growing a baby.
“We know that treating the underlying autoimmune condition appropriately and minimizing active inflammation during pregnancy is what actually results in better outcomes,” Dr. Stone explains.
Women shouldn’t make changes to their medication without talking to their doctor. Active inflammation in a mother’s body pulls resources away from her growing baby, which could result in a low birthweight, premature birth or even loss of pregnancy in extreme cases.
One exception for medication is methotrexate, which is used to control RA. This drug can make it difficult to maintain a pregnancy and can pose a higher risk of birth defects, Dr. Lord explains. If you plan to become pregnant and you take methotrexate, or the other biological parent for your pregnancy does, Dr. Lord advises talking with your provider about an alternative treatment.
3. Be aware that pregnancy can make your autoimmune disease improve…or not.
During pregnancy, some women may see their disease mellow out, while others might see it worsen. Some women might not notice any difference.
“Pregnancy has a strange, unpredictable and poorly understood effect on the immune system,” Dr. Lord says.
Work with your doctor to determine the best timing for pregnancy, and plan regular follow-up appointments to catch any flare-ups. Early treatment will minimize the impact on both you and your baby.
4. Expect to become very familiar with exam rooms.
The common refrain here is, plan to see your doctors regularly before, during and after pregnancy. In addition to having regular obstetric appointments, women with autoimmune disease should stay in communication with their autoimmune specialist throughout pregnancy and birth. Ask your doctor about your best course of action, and plan ahead so you can schedule the appointments you need.
These visits are a good time to bring along your partner, family member or friend.
“Pregnancy can be a challenging time for many women, with and without autoimmune disease, as the body goes through major changes to support an additional life,” sas Dr. Stone, a rheumatologist. “It may be helpful to have your support person come with you to doctor visits so they can hear the recommendations from your physicians.”
5. Remember your birth plan is only a guide.
In any pregnancy, regardless of an autoimmune disease diagnosis, what happens at birth is unpredictable. While the state of your body and disease may dictate how your baby is delivered, there are no hard and fast rules.
Women with Crohn’s disease may be concerned about the effects of a vaginal delivery on perianal disease, which some Crohn’s patients experience. But as long as a woman with Crohn’s has never had perianal disease or can keep it well controlled, says Dr. Lord, she can safely have a vaginal birth – no C-section required.
6. Prepare for an immune system jolt after your baby is born.
If pregnancy has tamed your autoimmune disease, birth may unleash it again.
“Whatever changed about your immune system during pregnancy will suddenly disappear as soon as you give birth,” Dr. Lord says. Women may experience flare-ups and need a stronger therapy postpartum.
Some women experience their autoimmune disease symptoms for the first time right after having a baby. Women with MS will likely see a reduction in their symptoms during pregnancy, but their risk for relapse doubles fairly soon after birth, says Dr. McCarthy, a neurologist. That’s when women should see their specialist to have an MRI and make adjustments to their medications as needed.
Again, be sure you are monitored by your doctor closely both during and after pregnancy to help you stay on top of your disease.
7. Plan ahead for life post-birth.
Breastfeeding is possible for moms with IBD, lupus, MS or RA, though it depends on which medications you take. Some pose risks to the baby through breastmilk, but others won’t. Your doctor can work with you on the best approach to take.
Any mom will be tired in the days and weeks following birth, and autoimmune disease flare-ups can make daily life even more challenging with an infant.
“Hope for the best but prepare for the worst,” advises RA blogger Mariah Z. Leach, who has chronicled her experiences with pregnancy and RA.
“Adjusting to life with a brand new baby is difficult enough all by itself,” she writes. “So try to do whatever you can to make that time period as easy as possible in advance of baby’s arrival.”
And if you do need help, don’t be afraid to ask for it, says lupus advocate Jenny Studenroth, a mother of two. “Sometimes, the small breaks these opportunities allow are just what you need to rest up and get back to being the mommy you want to be!”
Bottom line: Pregnancy with an autoimmune disease should be like any other.
Take it from the experts: If your disease stays in check before and during pregnancy, your experience likely won’t be any different from a pregnancy without an autoimmune disease.
Doctors’ knowledge about autoimmune disease and pregnancy continues to evolve, so talk with your provider for the most up-to-date information about how best to keep you and your baby healthy.
November 13, 2019
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This blog does not provide medical advice, nor is it a substitute
for professional medical advice, diagnosis or treatment.