The excitement of the inescapable reproduction test, for most expectant mothers, can be clouded with concern for a wholesome reproduction and baby. But, if you have Ra or Lupus, it can be multiplied. You also have to worry about if your reproduction will cause a flare-up, what medicines are safe for your baby, and either or not your condition will work on your growing fetus or your own long-term health.
This narrative addresses the issues of two, out of many, rheumatic conditions: rheumatoid arthritis (Ra) and systemic lupus erythematosus (lupus).
Ra and lupus are autoimmune diseases and in autoimmune diseases the immune system, which is suppose to safe your body from any foreign substances that may harm it, malfunctions and attacks your own body's tissues. If you have Ra or lupus you are probably taking medication that reduces the immune systems action to a greater or lesser degree. But reproduction has its own impact on the immune law and your law must make some adjustments so that your body won't charge what it perceives to be foreign, the genes that come from the father of your baby. These adjustments make it potential for your baby to grow safely. But there are other effects which can impact your rheumatic conditions such as Ra and lupus in separate ways.
Something to think about.
It can be hard to resolve either the changes in the way you feel are from the reproduction or your Ra or lupus. Unfortunately when you are pregnant you can become anemic, which can cause you to be tired and have a lack of energy, this also happens when you have Ra or lupus. Your reproduction will also work on inescapable markers of inflammation, doctors use blood test to portion your inflammation called a erythrocyte sedimentation rate or Esr, which is often high if you have Ra or lupus. These markers can also be high when you're pregnant so measuring Esr may not be the best way to gauge how active your Ra or lupus is. Also, your reproduction may make blood clots more likely, but if you have lupus, there is also an increased risk that you will have blood clots because there is a protein called antiphospholipid antibodies in your blood, and these proteins is what increases your risk.
Your reproduction can also cause musculoskeletal problems because as your baby grows, your ligaments will relax to allow the pelvis to stretch. You will also put on weight, which is a wholesome thing but this can cause your posture to convert which can effect in joint aches and back pain. Someone else thing is carpal tunnel syndrome (Cts), which causes wrist pain and numbness, is a base complication of your pregnancy, especially during the second and third trimesters but is is also associated with Ra and lupus. All these things can make it tricky to shape out either or not they are problems with the reproduction or are a part of your rheumatic conditions.
Things to do if you have Ra.
Ra generally affects the joints and it will make them stiff, painful, swollen and sometimes, unstable and deformed, but it can also cause fatigue and you may have problems with your heart and your eyes. There is between 1% and 2% of the United States habitancy that have Ra, and it is most base among women than men. It will ordinarily appear when you are in your twenties or thirties, the child bearing years, so finding women with Ra who are inspecting reproduction is not all that surprising.
The first thing you will want to know, if you have Ra and are inspecting having a baby, is either or not your arthritis is going to flare-up during your pregnancy. The thought of carrying nearby an extra 20 - 30 pounds of weight on replaced joints or on joints that are sometimes swollen and sore can be a bit discerning. Luckily there are about 70% - 80% of women who have Ra that go into remission during their pregnancy, Someone else words their symptoms go away. For the rest of those women with Ra who don't go into remission, their symptoms may become milder and easier to manage. It's hard to predict just who will go into remission but despite this uncertainty, some doctors will tell their patients to stop taking their Ra medications when they become pregnant because of the high likelihood that they will go into remission and not need treatment. But there are some steps you can take before you get pregnant that can help you during and after the pregnancy.
Work out a plan with your rheumatologist for what medication you will take if you do have a flare during your pregnancy.
You will also have to consider the type of delivery you will have. Most women with Ra can safely go through the labor and vaginal delivery, but if your Ra affects your pelvis and legs extensively, a vaginal delivery may not be what you want to do. Your physician may opt for a planned cesarean section.
For some of you with Ra, you may find that after you have your baby your arthritis flares up. Because arthritis flares can make it difficult to care for a newborn, you will want to plan very determined just how you will carry on this period. By planning you can ease the adjustment of this postpartum period.
If you are planning on breast feeding you will need to discuss this with your rheumatologist, obstetrician and pediatrician ahead of time. There are some Ra medications that are compatible with breast-feeding. Try to resolve which one you want to take just in case you have a flare after your baby is born.
If it's possible, try to have someone to help you at home during the transition time. If you are unable to, there are some things you can do to make it easier on yourself, such as; having some extra meals stashed in the freezer so that all you have to do is to pull them out of the freezer when things get difficult.
Planning is the key and it will go a long ways to helping you ease the stress of your worst flare. The good news is that Ra doesn't have a negative impact on the baby, it doesn't increase the rate of miscarriages, and it doesn't cause any problems in the baby.
What if you have lupus
If you have systemic lupus erythematosus, it's a bit more complicated. The theorize it's more involved is that lupus can work on many parts of the body, such as the skin, joints, kidneys, blood cells, heart and lungs. The most base symptoms are a rash on the face, pain and swelling in the joints and a fever with kidney disease being the most serious symptom. Lupus is more base in women then men and it will ordinarily show up when you are between the ages of 15 and 45.
Doctors of the past would often counsel women with lupus against getting pregnant based on the assumption that reproduction would all the time cause lupus flares, possibly serious flares, and that babies would do so well. These were and are valid concerns, but there is now a great insight of lupus and how to treat it that has made reproduction very realistic and a safe selection if you resolve to get pregnant.
There are some studies that have shown that being pregnant may increase your risk of flares and yet other studies that have found that it doesn't. This obscuring in part lies with how the separate researchers portion and define a flare. And also, during any nine-month duration you may have a flare or flares either you are pregnant or not, so flares during your reproduction are not exactly associated to your pregnancy. Headaches, fatigue, shortness of breath and joint pain are all symptoms of a lupus flare as well as the possibility being a part of your pregnancy. The most likely risk is that women with lupus have a slightly higher occasion of having a flare-up but for many women it can be controlled with medication.
You will most likely flare and not do so well during reproduction if your lupus was active at the time of conception. This will be the case if your lupus has affected your kidneys because reproduction will also stress your kidneys. Most doctors will generally not advise getting pregnant until you have been in remission from kidney disease and active lupus for six months.
The most ideal situation is if when you have decided to become pregnant, that you see your rheumatologist ahead of time so he can run blood tests that will resolve just how active your lupus is. The blood test will also originate a baseline that your physician can refer to later during your reproduction in case there are any difficulties. If you don't get these test done before you get pregnant then surely get them done shortly after. You will also want to consult with an obstetrician who has caress with treating women who have lupus or possibly an obstetrician who specializes in high risk pregnancies. It is also a good idea if when you become pregnant, you are taking medication to control you lupus and that you can continue to take them safely during your pregnancy. Although, if you have Ra you are able to stop taking your medications during your pregnancy, this may not be the case if you have lupus. You and your rheumatologist will need to plan for what medications you can take if you have a lupus flare during your pregnancy.
If your blood tests show that you have the antibodies called anti-Ro (Ssa) or anti-La (Ssb), you will have a small risk of having a baby born with a rare condition called neonatal lupus. The main symptom of neonatal lupus is a skin rash, and it will ordinarily disappear in six months. There is a very small ration of babies with neonatal lupus, about 2% to 5%, who will originate heart block, which causes the heart to beat abnormally. If you are known to have the anti-Ro or anti-La antibodies, you will probably have an ultrasound at 18 to 24 weeks into the reproduction to see if there is heart block. The physician may prescription a corticosteroid in an attempt to treat the heart block if there is one. Although, explore doesn't show a clear benefit of doing this. It may become principal to deliver the baby early but most babies born with heart block need to have a pacemaker implanted, wither at birth or later in life.
There are other complications that come with lupus and that includes preeclampsia, premature rupture of the membranes, which means the baby will be born prematurely, and low-birth-weight babies. In preeclampsia, or pregnancy-induced hypertension, you will have high blood pressure and preserve fluid among other symptoms. Preclampsia is thought to be more base if you have lupus and most often it can be hard to distinguish between preeclampsia and a lupus flare. But if it's not treated appropriately, preeclampsia can damage your kidneys and liver as well as increase the risk for a miscarriage and premature birth or even cause the baby to be very small. If you have preeclampsia your physician may advise that you deliver the baby early, either by induced labor or a C-section.
The same guidance that applies if you have Ra applies to you if you have lupus as far as the duration after the birth of your baby. Planning makes all the disagreement and having help lined up in case you have a lupus flare prevents you from taking care of your baby. As with Ra, you will want to have ready-to-eat meals in the freezer and be sure to know what your options are in terms of breast-feeding and medications.
As you can see, there are some very extra considerations for you if you have lupus and are inspecting having a baby, but if you have a clear insight that your chances are good that our outcome will be nearly as good as someone who doesn't have lupus. Remember that the best approach is to have your condition care team, your rheumatologist and obstetrician, working hand in hand and also good transportation and close follow-up with this these team members is the key.
Your medications
There are many medicines that are used to treat Ra and lupus that are relatively safe during pregnancy, but some of the drugs used for rheumatic conditions increase the risk of birth defects, and it's also leading to remember that birth defects occur in about 3% of pregnancies where the mother doesn't take any medications. When you are inspecting if a medication is safe during pregnancy, you should resolve if the risk of birth defects is greater than 3%. Your physician should be able to help you shape it out.
Nsaids: Non-steroidal anti-inflammatory drugs treat the pain and inflammation of arthritis. These Nsaids contain the Cox-2 inhibitor celecoxib (Clelbrex) and former Nsaids such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) and the many other, both prescription and over the counter. There are studies in animals that have shown that Nsaids can cause birth defects, but there hasn't been any findings in humans. It is potential to take these medicines safely during your reproduction up to the third trimester. Taking Nsaids during the third trimester, will increase the risk that one of the baby's heart vessels will close prematurely, a good theorize to stop taking them at 24 weeks of pregnancy. If you are trying to get pregnant you may want to stop taking the Nsaids, along with Cox-2 inhibitors, from the time of ovulation until their next menstrual duration because there is a hypothetical risk that these medicines will interfere with the implanting of a fertilized egg.
Corticosteroids: Corticosteroids decreases the inflammation throughout the body and these drugs are often the mainstay of treatment for habitancy with inflammatory conditions such as Ra and lupus. Prednisone and prednisolone are the most generally prescribed drugs that your physician will give you and you can continue to take these medicines during your reproduction if you need to. But before you do, remember that if you take the corticosteroids during the first trimester of your pregnancy, your baby could be born with a cleft palate. This risk is still fairly low, with cleft palate happening in approximately 1 in 300 babies exposed to the drugs in the womb compared to 1 in 1,000 when there is no exposure. Babies born to mothers who take corticosteroids during reproduction are also more likely to be smaller and born prematurely. They also will raise your risk of reproduction induced hypertension, gestational diabetes, a form of diabetes that happens only during pregnancy, and pregnancy-induced osteopenia or bone thinning. Corticosteroids are often a reasonable selection during reproduction for the management of both Ra and lupus despite the potential side effects.
Hydroxychloroquie: It was thought that hydroxychloroquine or Plaquenil, was not compatible with reproduction but over the past decade that idea has changed. Right now most rheumatologists in the United States and elsewhere with patients who need hydroxychloroquine to keep their condition stable will keep them on it during their pregnancy. Studies have been done to substantiate the claim that the treatment might cause problems with the improvement of the fetus's visual and hearing systems, but the studies didn't prove it.
Sulfasalazine: Sulfasalazine or Azulfidine, is determined to be safe to use when you are pregnant.
Azathioprine and cyclosporine: These drugs are immunosuppressive drugs that are used generally to say organ transplants. Doctors will also subscribe them to treat Ra and lupus. There is data from world wide transplant registries of well thousands of babies that were exposed to these medications in the womb. This data shows that there were no increased rates of birth defects, but the babies do seem to be smaller and to be born earlier. There are many doctors will use these medications if they need to control Ra or lupus action in women who are pregnant.
Methotrexate, leflunomide, mycophenolate mofetil, cyclophosphamide: These medications can cause early fetal death and birth defects at a rate higher than what you would expect. You shouldn't take them during your reproduction and also if you are planning a reproduction you should stop taking methotrexate or CellCept at least one menstrual cycle before trying to get pregnant. If you're a man taking these medications then you will want to stop taking them three months ahead of time. If you are taking leflunomide you will need to to stop taking it two years before you try to get pregnant, or you could under go a two-week procedure to wash the treatment out of your bloodstream.
Biologics: There isn't enough data to stop either or not this newer type of drug is well safe during pregnancy. However, we do know that Tnf-alpha blockers, etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira) may lead to birth defects agreeing to new evidence. You will want to stop taking biologic drugs before trying to become pregnant.
In just about all circumstances, if you have Ra or lupus, you can be sure it is safe to become pregnant as long as you are sure your Ra and lupus are under control and your reproduction is planned. If you have lupus it is particularly leading to keep the communications open with your rheumatologist and that you have an obstetrician that is experienced in dealing with women with lupus or high risk pregnancies. With particular monitoring and the accepted use of your medicines, it will be potential to successfully carry on your reproduction when you have Ra or lupus.
What to Do If You Are Pregnant and Have Lupus Or Ra