Additional Resources

Women living with inflammatory arthritis, and rheumatic diseases, who want to start families often have questions. Am I able to get pregnant? Will I pass my disease to my child? Do I need to stop taking my medications during pregnancy? What will happen to my disease once I’m pregnant? Will I experience arthritis flares after I give birth? Can I breastfeed my baby? Will I be able to raise my kids?

“It’s a misconception that arthritis is an older person’s disease,” said Dr. Mary De Vera, a senior scientist at Arthritis Research Canada. “Arthritis impacts whole families – the mother with arthritis, her unborn baby, her healthily born baby and her partner.”

When it comes to arthritis and pregnancy, it’s important to start the conversation early. “A planned pregnancy is the best pregnancy,” said Dr. Neda Amiri, a rheumatologist and clinician investigator at Arthritis Research Canada. “I make a joke with our patients that, even before your partner, we should know if you are planning to have kids.”

If you are living with arthritis and considering pregnancy, explore some of the helpful resources on this page and use them to start a conversation with your rheumatologist.

Frequently Asked Questions

Is it possible to have children when living with inflammatory arthritis?

It is definitely possible to have inflammatory arthritis, or rheumatic disease, and still have a family and be pregnant. However planned pregnancy is the best pregnancy.

How can I prepare for pregnancy with arthritis?

Talk to your rheumatologist. It’s ideal to achieve low disease activity or remission before pregnancy. Patients also need to be on pregnancy compatible medications. A lot of medications are safe to use in pregnancy and breastfeeding, but some are not. Some women will need to transition to pregnancy compatible medications before trying to conceive. Once someone is pregnant, doctors will then look at how the disease can impact the pregnancy, outcomes and how the pregnancy may impact the way the disease behaves.

Does arthritis affect fertility?

Most rheumatic diseases do not affect fertility or a couple’s chances of becoming pregnant. The only exception is that some data has shown that it might take people who have rheumatoid arthritis or ankylosing spondylitis longer to get pregnant. We don’t understand all of the factors that play into that, but one of the concerns that has been raised is that too much use of anti-inflammatories, or what we call non-steroidal anti-inflammatory medication, such as ibuprofen, may impair ovulation and, therefore, chances of becoming pregnant. We also know that, for individuals living with lupus or connective tissue diseases, fertility is not affected but they may have higher chances of miscarriage.

Why does arthritis need to be well-managed before pregnancy?

Arthritis can strike during childbearing years for females and males and active arthritis is a risk factor for many adverse pregnancy outcomes or complications. Research has shown that, when a female is in flare, they are more likely to have a miscarriage. They are also more likely to go into labour early, and have babies with low birth weigh and birth defects. Moms and babies are also more likely to experience infections.

Why is contraception important for women living with arthritis?

Using contraception is important for people living with rheumatic diseases because some medications are not safe to take during pregnancy. Therefore, contraception needs to be used to prevent unplanned pregnancies while taking these medications. Most contraceptives are safe for people living with rheumatic diseases. The exception to this is if someone has lupus, antiphospholipid antibody syndrome, or antiphospholipid antibodies, as some contraceptives are not recommended. Individuals should discuss contraceptive options with their rheumatologist, family physician or obstetrician.

How likely is it that I will pass arthritis to my baby?

It’s very hard to estimate an exact risk of passing down a disease, like rheumatoid arthritis, to an infant. Multiple factors determine whether a person will develop a rheumatic disease. Having a genetic predisposition is just one part of the equation. Environmental factors play a role. There is also the concept of epigenetics – how behaviours and environment affect the way genes work. So, even if a gene gets passed down, if it is turned off, it’s unlikely that it will cause concern. Rheumatologists often use the Swiss cheese model to explain risk. In order for someone to get a disease like rheumatoid arthritis, you have the first slice of cheese and it has some holes in it and maybe you have the gene. Then there is the next layer of cheese and it has different holes, for example, depending on whether you smoke. The next layer includes major life stressors. Did you get a virus that made your immune system go haywire? A lot of different things have to happen. Individuals with first-degree relatives with inflammatory arthritis are at a higher risk of developing that disease, but the vast majority of them do not.

What if the father has arthritis? Can he pass it to the baby?

We don’t know whether it infers a higher risk if that genetic risk, or genetic predisposition, comes from the father’s side or the mother’s side. We just know that, if you have a first-degree relative with an autoimmune disease, such as rheumatoid arthritis, your risk of having that disease is higher, probably two times that of the general population.

What medications aren't safe during pregnancy?

One of the more common medications used in rheumatology, that is not safe in pregnancy, is methotrexate. If someone is taking this medication, it needs to be stopped prior to conception. Once the medication is stopped, rheumatologists then observe to see if an individual flares without the drug. If they flare, it’s not ideal for them to become pregnant until inflammation is controlled. An alternate, pregnancy-safe medication then needs to be tested. Once on the new medication, a six-month observation period is recommended to make sure the new medication regimen is working and that the person is stable and doing well. There are other arthritis medications not considered safe in pregnancy, so individuals should talk to their rheumatologist before tying to get pregnant.

Does it matter if the father is on arthritis medications during conception?

The vast majority of data, when it comes to men and arthritis medications, suggests that the medications a father is on does not have any impact on the developing baby. The only exception to this is if the man is on cyclophosphamide, which is used in severely sick patients with either autoimmune diseases or, in some instances, cancers. People taking this medication need to wait at least three months before trying to have a baby.

How does pregnancy affect arthritis flares?

Pregnancy affects different diseases in different ways because of the immune shifts that can happen in pregnancy. For example, it is an old saying that “Every patient who has rheumatoid arthritis gets better in pregnancy.” It is true to an extent that, if someone has really high disease activity with 20-30 swollen joints, they will experience some improvement in pregnancy, However, taking arthritis medications that are safe in pregnancy is better than relying on the pregnancy effect alone. On the other hand, diseases like lupus can flare in pregnancy. There is a 10-30 per cent risk of people with lupus experiencing flares in pregnancy, and this is in individuals who go into pregnancy having a low disease state or being in remission. If someone goes into pregnancy with lupus, having moderate to high disease activity can be a recipe for disaster with worsening disease and much higher risk of flares.

Is it safe to stop taking my arthritis medications during pregnancy?

When it comes to rheumatic diseases and medications in pregnancy, what we know for sure is that stopping medications cold turkey, or stopping them suddenly without having any alternative plan, is usually a recipe for disaster. Doing so will lead to a flare of the disease potentially in pregnancy and adverse outcomes for the mom and baby.

We know a lot of medications in the category of conventional, synthetic disease modifying anti-rheumatic drugs (DMARDs) are safe. So, this includes hydroxychloroquine, sulfasalazine, and azathioprine. These medications are safe in pregnancy and breastfeeding. Biologics are a relatively newer class of medications that have been around for about 20-25 years. We now have a lot of data when it comes to anti-TNF biologics and we know them to be safe and compatible throughout pregnancy and breastfeeding. When it comes to other biologics, we don’t have as much data to make strong recommendations/guidelines. Therefore, individualized discussions in terms of whether someone should continue their medications in pregnancy are needed. For the most part, biologics are continued during pregnancy.

What is the Pregnancy and Rheumatic Diseases Clinic?

The Pregnancy and Rheumatic Diseases Clinic is located at the Mary Pack Arthritis Centre in Vancouver. This clinic opened in 2017 and is a unique model in British Columbia, as it is the only clinic in the province where rheumatologists, family physicians and obstetricians can refer patients with underlying rheumatic diseases who are either pregnant or planning to become pregnant.

For patients who are not yet pregnant, clinic physicians meet with them prior to pregnancy and go through a pre-pregnancy checklist. That list includes things like disease state, medications, information about previous pregnancies and pregnancy outcomes and having a conversation about what needs to happen before proceeding with pregnancy.

If it is determined that it is not a good time to proceed, physicians make recommendations around what changes need to happen. If necessary, follow up is done to make sure an individual is in the optimal state. After someone is pregnant, the clinic follows them once every trimester in pregnancy, assuming they are doing well, sometimes with increased monitoring if they experience complications. Clinic physicians liaise with maternal fetal medicine specialists and obstetricians to work as a team of doctors for the patient.

After delivery, around the 2-3 month mark, physicians meet with women to see how delivery went, discuss any increased disease flares or symptoms, and review medications to ensure they are compatible with lactation or breastfeeding. The clinic also reviews infant immunization schedules, as women on some medications, especially biologics, may need to alter their infant’s vaccination times.

Is it safe to breastfeed while on arthritis medications?

Absolutely.  A lot of arthritis medications are safe with breastfeeding and breastfeeding is encouraged.

Videos

Dr. Neda Amiri on Supporting Women with Rheumatic Disease in their Reproductive Journey

In this Arthritis Broadcast Network video, Arthritis Research Canada’s Dr. Neda Amiri discusses how to support women with rheumatic diseases during their reproductive journeys.

Pregnancy & Lupus

Arthritis Research Canada’s Dr. Neda Amiri talks family planning and pregnancy in lupus at the 2024 BC Lupus Symposium.

Considerations for Pregnancy & Equity & Diversity in Research

In this Arthritis Broadcast Network video, Arthritis Research Canada’s Dr. Mary De Vera discusses arthritis and pregnancy, as well as equity and diversity in research.

Medication Adherence, Lupus, Pregnancy

In this Arthritis Broadcast Network video, Arthritis Research Canada’s Dr. Mary De Vera discusses medication adherence, research grants, lupus, and pregnancy.

Pregnancy, Parenting & Arthritis

This Arthritis Wellness Conversation covers common questions and concerns about the management of arthritis during pregnancy, as well as tips and strategies for parenting with arthritis.

Arthritis Medication & Pregnancy: Is It Safe? 

Arthritis Research Canada’s Dr. Mary De Vera discusses research findings on arthritis and medication safety in pregnancy.

Articles

Arthritis & Women's Health: What You Need to Know

Over six million Canadians live with some form of arthritis. Nearly 60 per cent of those people are women. Discover advice and research on monthly hormone changes, birth control, pregnancy, menopause, medication safety and cervical cancer risk from two Arthritis Research Canada experts. Read More

More Support Needed for Patients with Rheumatoid Arthritis Looking to Start Families

New study highlights need for more support for female patients with rheumatoid arthritis and their partners when it comes to family planning and reproductive decisions. Read More

Supporting People with Disabilities in Pregnancy

Pregnancy and those first months following a birth come with a mixed bag of experiences – from joy and wonderment to morning sickness, back pain, and exhaustion. These challenges are made more complex when people with disabilities have to navigate a healthcare system that was not made with them in mind. Read More

Parenting with Arthritis

Eileen Davidson could barely hold her son when he wasn’t even two years old. It hurt too much. Her body felt weak and her mind was in turmoil. Daily life became intolerable with unrelenting fatigue and intense pain caused by rheumatoid arthritis. Davidson is a single mother and doesn’t have the option of taking a sick day from life. Managing her health and arthritis became her full-time job. Read More

7 Strategies for Parenting While Living with Arthritis

Parenting is very demanding – and every stage of childhood presents new challenges. For parents also living with the pain and fatigue of arthritis, parenting can become even more complex. While each family is unique, here are seven strategies from the Canadian Arthritis Patient Alliance that might help. Read More

Rheumatoid Arthritis and Family Planning: Understanding the Partner Perspective

The decision to have a baby is a big one. Throw a serious disease like rheumatoid arthritis into the equation and starting a family can feel overwhelming. According to new research, more resources are needed to support women living with this disease, as well as their partners, in family planning and making reproductive decisions. Read More

Research Reveals Potential Care Gap for Pregnant Women with Lupus

A study by Arthritis Research Canada found that almost 30 per cent of pregnant women with systemic lupus erythematosus discontinue their antimalarials (especially in the first trimester) despite these medications being safe and recommended during pregnancy. Read More

Helpful Links

Pregnancy & Rheumatic Diseases Clinic at Mary Pack

This clinic opened in 2017 and is a unique model in British Columbia, as it is the only clinic in the province where rheumatologists, family physicians and obstetricians can refer patients with underlying rheumatic diseases who are either pregnant or planning to become pregnant. Learn More

Pregnancy and Parenting with Arthritis: A Resource for Patients by Patients

Are you contemplating a step into parenthood and also live with inflammatory arthritis? Start with these resources written for patients by patients with arthritis. Learn More

The MotherToBaby Podcast

MotherToBaby is a source of evidence-based information on the benefits and risks of medications and other exposures during pregnancy and while breastfeeding.

Learn More

Pregnancy, Birth and Beyond

Now that you are pregnant, you may be wondering if your arthritis will feel better, worse or the same. Everyone is different, but there are a few studies that tell us a little bit about what to expect.

Learn More