Arthritis and pregnancy - Living with arthritis A practical guide to bumps, births, babies and beyond - Arthritis Australia
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Living with arthritis Arthritis and pregnancy A practical guide to bumps, births, babies and beyond
How can this booklet help you?
Becoming a parent is one of the most exciting and
overwhelming times in most people’s lives.
But even more so if you, or your during conception, pregnancy,
partner, has arthritis. delivery and breastfeeding
This booklet has been written to • plan for life with your new baby,
help support you as you make one and
of the biggest decisions of your life, • find support and additional
starting a family. information to cope with the
It offers information and practical journey towards parenthood.
advice to help you and your partner: The information inside is based on the
• prepare for pregnancy latest research and recommendations,
and has been reviewed by Australian
• understand the safety and arthritis experts, as well as many
potential risks of arthritis parents with arthritis, to make sure it
medications before conception, is current and relevant to your needs.
Medical and consumer consultants
Dr Claire Barrett, Rheumatologist
Julie Black, CEO, Arthritis SA Proudly sponsored by an
Lyn Crossley, Health Educator – Occupational Therapist, unrestricted educational
Arthritis SA grant from:
Wendy Favorito, Consumer
Sharon Lee, Consumer
Suzie May, Consumer
Dr Margaret Mazur, Rheumatologist
Jean McQuade, Consultant, Special Projects, Arthritis WA
Denise O’Connell, Health Educator – Dietitian, Arthritis SA
Associate Professor Susannah Proudman, Rheumatologist
© Copyright Arthritis Australia 2018
2 Arthritis and pregnancy
Contents
I have arthritis...is having a family possible? 4
Does having arthritis make it harder to fall pregnant? 4
Is there an increased risk of miscarriage or problems
during pregnancy if I have arthritis? 5
Can arthritis be passed on to my unborn baby? 6
We want to start a family – what do I need to consider? 7
Get the right advice – see your rheumatologist
before planning for pregnancy 7
Questions for your healthcare team 7
Does it matter how active my arthritis is before I conceive? 8
What about men with arthritis? 9
When is the best time to start trying for a baby? 9
What is the current evidence about medication
safety during pregnancy and breastfeeding? 10
Unplanned pregnancy 10
Pregnancy and arthritis – what can I expect when expecting? 12
How will I feel during pregnancy? 12
Pregnancy and arthritis remission 12
Physical effects of pregnancy 12
Emotional health during pregnancy 14
Lupus and pregnancy 15
Planning 15
During pregnancy 15
Neonatal lupus 16
Labour and delivery 17
Life with a new baby 18
Caring for a new baby 18
Breastfeeding and bottle feeding 22
Post-natal flare 25
Seeking support 25
Who can help? 26
Useful resources 27
Glossary 29
You might notice some medical words are highlighted in pink print when they’re
first used. You’ll find an explanation of these words in the glossary on page 29.
Arthritis Australia 3
I have arthritis…is having
a family possible?
Absolutely. It might require extra Does having arthritis make
planning and patience, or not it harder to fall pregnant?
be quite as you pictured it, but
becoming a parent is usually possible Conceiving a baby may take longer
if you have arthritis. if you, or your partner, have arthritis
but experts are not exactly sure how
The journey to parenthood can be or why.
uncertain and demanding, often
both physically and emotionally, and Studies have shown that women with
sometimes more so if you are living rheumatoid arthritis do take longer
with arthritis. to conceive, often longer than 12
months. Experts aren’t sure why this is
Living with joint pain and other
symptoms can make it challenging the case. It could be due to the disease
to care for a new baby or an active itself or some arthritis medications,
toddler. such as anti-inflammatory medications.
Other factors such as lower sex drive
However, with proper planning and due to fatigue and pain might also
medical care, most people with
play a role.
arthritis can have safe, successful
pregnancies and become loving, There is very little known about
capable parents. whether fertility is affected by
psoriatic arthritis and ankylosing
The first step on spondylitis.
the path towards Women with lupus may have a
higher risk of complications during
parenthood is to discuss pregnancy but most are able to have
your family plans with children. See the section about lupus
your rheumatology team and pregnancy for more information.
before you start trying Whatever your type of arthritis, your
for a baby. rheumatologist can help guide you
as you plan to conceive.
4 Arthritis and pregnancy
They can also refer you to other science have made treatments for
specialists, such as an obstetrician, fertility challenges more effective.
to improve your chances of getting If you have any concerns about
pregnant if you’re having difficulties your fertility, speak to your GP or
conceiving. rheumatologist who can refer you to
a fertility specialist.
It can be a lonely, emotionally
draining experience if it’s taking
longer than you had hoped to fall Is there an increased risk
pregnant, especially if you have of miscarriage or problems
ceased some of your medications during pregnancy if I have
in order to conceive safely. It is
estimated that as many as one
arthritis?
in six couples in the Australian Most studies have found that the
population have trouble conceiving, rates of miscarriage for women
so if this is an issue for you you are with rheumatoid arthritis are no
definitely not alone. The good news different from rates for women
is that advances in medicine and without arthritis.
Arthritis Australia 5
There is also no increased risk of Can arthritis be passed on
miscarriage if the father has arthritis. to my unborn baby?
Most types of arthritis that are well For most types of arthritis the chance
controlled don’t increase the risk of of your child having arthritis is low.
complications during pregnancy or Even though some types of arthritis
cause harm to the unborn baby. appear to run in families, there are
Highly active, or poorly controlled, many other factors involved other
arthritis can cause risks for both you than just the genes your baby
and your unborn baby so it is vital to inherits from you and your partner.
work with your rheumatology team If you are worried, it’s a good idea
to find a management plan that to talk to your rheumatologist for
works for you. more specific information about your
particular type of arthritis.
Women with lupus can have a
higher risk of miscarriage and other
pregnancy complications, usually
requiring closer monitoring from
specialists. See the section about lupus
and pregnancy for more information.
6 Arthritis and pregnancy
We want to start a family - what
do I need to consider?
Get the right advice – see talk to your rheumatologist before
your rheumatologist before you stop taking any of your arthritis
medications. Remember, there are
planning for a baby
many arthritis medications that can
Some of the medications used to be safely used before and during
treat arthritis can be taken safely pregnancy.
before and throughout pregnancy.
Some can be used at certain
times during pregnancy. Others Questions for your
are harmful to a growing baby so healthcare team
shouldn’t be used during pregnancy. Here are some things to discuss with
Some medications remain in your your healthcare team, such as your
body for many months after you stop rheumatologist, rheumatology
taking them so you may need to wait nurse and GP before you start
a while before trying to conceive. trying to conceive:
If you or your partner has arthritis, 1. Are there any medications in my
make it a priority to talk to your treatment plan that I should stop
rheumatologist at least six
taking while I’m trying to fall
months before you start trying
pregnant or when I am pregnant?
to conceive.
If yes:
Your rheumatologist can give you
a. How long should I stop taking
advice about the safest combination
the medication(s) before I start
of medicines to continue taking during
trying for a baby?
conception and pregnancy, other
treatments you could use while trying b. What are my other options to
to conceive, and which medicines help manage my symptoms
should be stopped before conception while I can’t take my usual
(and when you should stop them). medication?
Suddenly stopping your medications 2. Are there any medications for
could make your arthritis worse, arthritis that are safe to continue
which can cause health problems while I’m trying for a baby, and
for both you and your baby. Always during pregnancy?
Arthritis Australia 7
Does it matter how
active my arthritis is
before I conceive?
3. Do I need any vaccinations You might be eager to
before trying for a baby, or if my start a family but your
medications are changing? rheumatologist only wants
4. Should I be taking any particular to talk about how to get
supplements before trying to fall your arthritis under better
pregnant? control.
5. When would be the best time for Why does it matter whether
my partner and I to start trying for your arthritis is active if
a baby? you’re trying to conceive?
6. What is the best type of Conceiving while your
contraception we should be using arthritis is not well
while we’re waiting to conceive? controlled or highly active
can cause risks for both you
7. Are there any particular tests I and your unborn baby.
need before trying to conceive?
Having your arthritis well
Your medical team should be able controlled may:
to work with you to come up with
a treatment plan that protects the • make it easier for you to
health of your unborn baby, while conceive
also keeping your arthritis under • reduce your chance of
control. Be mindful that treatment requiring a caesarean
plans may need to change, or you section to deliver your
may need to try a range of different baby
medications to find the right
treatment for you during this period. • reduce the chance of
your baby being born
If you find it hard to talk openly prematurely, or having a
and honestly with your doctor low birth weight
about your options or concerns,
write down your questions before • prevent permanent joint
the appointment. You can also damage and disability.
consider seeking a second opinion It is vital to work with your
from another rheumatologist with a rheumatology team to find a
special interest in pregnancy. plan that works for you and
puts you on the path to a
healthy pregnancy and baby.
8 Arthritis and pregnancy
What about men with controlled or stable. While you might
arthritis? get a sense of this yourself from
monitoring your own symptoms, it
If you are a man with arthritis and
is important you discuss with your
you are thinking about starting a
rheumatologist whether your arthritis
family, your medications could also
is stable.
affect your fertility or your unborn
baby. Most medications can still If your arthritis is not well controlled,
be taken but some may need to you may find it harder to conceive
be stopped, possibly for several and there can be risks for both
months, before trying for a baby. you and your unborn baby. Talk to
Some medications can reduce your your rheumatologist about the best
sperm count, although this is usually management plan that will give you
reversed when you stop taking them. the best chance of achieving your
goal of becoming a parent while also
Talk to your rheumatologist at
protecting the health of you and
least six months before you and
your baby.
your partner plan to conceive.
You may also need to wait after
Your rheumatologist can give you
stopping certain medications; for
advice about the best treatment
example methotrexate needs to be
plan to follow before conceiving.
stopped at least three months before
Be vigilant with contraception to
trying to conceive.
prevent unplanned pregnancies until
you are ready to conceive. Stop smoking and avoid recreational
drugs to reduce the risk of harm to
your baby. Eat a healthy balanced
When is the best time to diet, lose any extra body weight, start
start trying for a baby? taking a folic acid supplement and
The best time to start trying for a lead a healthy lifestyle to further boost
baby is when your arthritis is well your chances of a healthy pregnancy.
Arthritis Australia 9
What is the current
evidence about medication
safety for pregnancy and
breastfeeding?
If you are planning a pregnancy it is
vital to get an expert opinion from
your rheumatologist about your
medications as early as possible. Unplanned pregnancy
Some arthritis medications are safe to
If you, or your partner, have fallen
continue before and during pregnancy.
pregnant unexpectedly, call your
Other medications may need to be
rheumatologist or treating doctor
stopped as they may increase the risk
immediately.
of miscarriage or cause harm to a
developing baby. Your rheumatologist If you are taking any of the
will work with you to find the right medications from the Not safe
arthritis management plan for both column in the table on page 11
your health and the health of your that are not safe during pregnancy,
unborn baby. stop taking them as soon as you
find out you are pregnant.
The current evidence about the
safety of arthritis medications If you are taking any of the
is summarised on the adjacent medications from the Generally safe
page. This is a general guide or May be safe columns in the table
only. New information is being on page 11, continue taking them
discovered regularly and advice as usual until you speak to your
may be updated. Use this table to rheumatologist. Do not stop taking
discuss your medications with your these medications without first
rheumatologist and always follow talking to your rheumatologist and
their expert advice. getting the right advice.
10 Arthritis and pregnancyGenerally safe May be safe Not safe
These medications are These medications may These medications
generally safe to be be safe during pregnancy should not be taken
taken and can usually be and breastfeeding but during pregnancy and
continued throughout there may be limited breastfeeding as they
pregnancy evidence for their can cause harm to a
and breastfeeding. safety. Talk to your developing baby. Talk
rheumatologist for more to your rheumatologist
information. about WHEN to stop
taking these medications.
They can help you plan to
transition to a medication
that can be safely used
during pregnancy. In the
event of an unplanned
pregnancy, stop taking
these medications
immediately and call your
rheumatologist.
COMMONLY USED BIOLOGICAL DMARDS • Cyclophosphamide
DMARDs • Abatacept • Leflunomide
• Azathioprine • Anakinra • Methotrexate
• Hydroxychloroquine • Rituximab • Mycophenolate
• Sulfasalazine • Tocilizumab • Tofacitinib
TNF INHIBITORS* NSAIDs
• Adalimumab
• Certolizumab
• Etanercept
• Golimumab
• Infliximab
UNCOMMONLY
USED DMARDS
• Cyclosporin
• Tacrolimus
CORTICOSTEROIDS
* Some TNF inhibitors are recommended to be stopped in the later parts of pregnancy.
Talk to your rheumatologist for more information.
Arthritis Australia 11Pregnancy and arthritis – what
can I expect when expecting
The day you’d been hoping for Pregnancy and arthritis
has arrived...you’ve had a positive remission
pregnancy test and you are now
During pregnancy, your immune
taking your first steps towards
system goes through some changes to
parenthood. Congratulations! allow your baby to grow and develop.
For some women with arthritis,
How will I feel during these changes to the immune system
pregnancy? also bring a benefit of reducing
The greatest myth of pregnancy… the activity of their arthritis. It is
the pregnancy glow! thought that about half of women
with rheumatoid arthritis will find
How your body will respond to that their symptoms, such as pain,
pregnancy, and how you will feel stiffness and flares, improve during
during the next nine months, will pregnancy.
be different for everyone. Every
However there are many women
woman is unique and every woman’s
with arthritis who continue to
pregnancy is also unique.
have active disease during their
Some women sail through pregnancy pregnancy. You may even find that
and even find that that their arthritis your symptoms worsen, or you have
symptoms go into remission (their disease flares, particularly if you’ve
symptoms improve or completely had to stop or change medications.
disappear) during pregnancy. But
that does not happen for every Physical effects
mother-to-be.
of pregnancy
However the pregnancy ‘glow’ Pregnancy brings with it many
that fills our newsfeed is a physical changes to your body. If
myth for many women, even you are living with arthritis, some of
without arthritis. Pregnancy can these changes may even make your
bring with it many unpleasant arthritis symptoms feel worse. Here
symptoms, which can be even more are some common symptoms in
challenging if you have arthritis. pregnancy and tips for managing:
12 Arthritis and pregnancySee your
Symptom What you can do
healthcare team if:
Extra pain and pressure Wear comfortable, You need advice about
on your hips, knees, supportive footwear. how best to stay active
ankles and feet as you during pregnancy or how
Exercise in water, rather
gain weight to adapt your exercise
than walking or standing.
program.
Reduce time standing –
Your joints are unusually
sit on a stool as you are
warm, swollen and
preparing food and think
painful – seek advice from
about how you can do
your rheumatologist.
things differently at work
to avoid prolonged time
on your feet.
Increased low back pain Sit and stand with good Your back pain is
as your tummy grows and posture. limiting your ability to
your posture changes, or move, walk or stand. A
Stay as active as you can
due to loosening of the physiotherapist can advise
within your pain limits.
pelvic ligaments on suitable exercises to
Sleep with a body pillow support and strengthen
to support your hips/ your back, and how best
pelvis as you sleep. to move without putting
strain on your back.
Use heat packs on your
sore back.
Swelling of your feet and Elevate your feet when Swelling becomes severe,
hands. you can. or your joints are more
painful and feel warm to
Try splints and braces.
touch – seek advice from
Use aids and devices to your rheumatologist.
reduce stress on hands.
Tiredness/fatigue Stay active and continue Your arthritis symptoms
with your exercise plan. are also worsening –
seek advice from your
Give yourself periods of
rheumatologist.
rest throughout the day if
possible.
Eat a healthy, balanced
diet.
Arthritis Australia 13Changes in
your hormone
levels can leave you
Emotional health during
pregnancy
feeling like you’re
Pregnancy can have a powerful on an emotional
effect on your mood, thoughts and rollercoaster at times
emotions. Changes in your hormone
levels can leave you feeling like
you’re on an emotional rollercoaster
at times, not to mention the impact Talk to your GP or obstetrician about
of possible morning sickness, how you’re feeling and they can
physical changes and bone-crushing suggest the best treatment options.
tiredness. Some emotional ‘ups You can also call the Perinatal
and downs’ are a normal part of Anxiety & Depression Australia
pregnancy. However if are feeling (PANDA) National Helpline on
constantly sad, worried, scared or 1300 726 306 for advice.
nervous, thinking negative thoughts
about yourself, or are finding it
difficult to sleep, eat or do the usual
activities in your life, seek support.
14 Arthritis and pregnancyLupus and pregnancy
Many women with lupus will have During pregnancy
normal, safe pregnancies. However, Many women with lupus will have
having lupus can increase the risk safe, healthy pregnancies.
of complications during pregnancy,
so your healthcare team will closely Some women with lupus will have a
monitor you throughout your higher risk of complications, such as:
pregnancy. You may also be referred • Miscarriage. This can also occur
to an obstetrician and hospital that later in the pregnancy, up to 24
specialises in high-risk or complex weeks. This is more common if
pregnancies. you also have antiphospholipid
Women with very severe or syndrome (APS), which affects
uncontrolled lupus may be advised about one in four women with
against having a baby. If organs, lupus.
such as the heart, lungs and kidneys, • Flares of your lupus symptoms,
have been damaged by lupus, they either during pregnancy or after
can be put under greater, even life giving birth.
threatening, strain by pregnancy.
• High blood pressure.
Planning
Try to plan your pregnancy
when your disease has been well
controlled, or in remission, for at
least six months before you conceive.
The healthier you are before you get
pregnant the greater your chance of
a successful pregnancy and a healthy
baby. Getting pregnant when your
lupus is active increases the risk of
serious health problems for you and
your baby and is not recommended.
Arthritis Australia 15• Your baby being born complications early, and keep you
prematurely. and your baby as healthy as possible.
• Your baby having low birth
weight. This is more likely if Neonatal lupus
you have APS as this can affect
About one in three women with
the ability of the placenta to
lupus have the SSA-A/Ro antibodies
supply your baby with enough
(proteins made by the immune
nourishment, resulting in your
system). These can cause symptoms
baby’s growth slowing.
of lupus in the baby when it’s
• Developing pre-eclampsia. This is born. This is called neonatal lupus.
a condition where you have high The baby may have a skin rash,
blood pressure and/or protein in unusual blood count and, in one to
your urine. It is a serious condition two percent of cases, an irregular
that can put the lives of both heartbeat that may need specialist
yourself and your baby at risk, treatment. If you have this antibody
and your baby might have to be it is very important you attend your
delivered early. regular antenatal appointments. In
Your obstetrician and healthcare most babies, neonatal lupus goes
team will monitor you regularly away after three to six months and
to help detect and treat any does not return.
16 Arthritis and pregnancyLabour and delivery
Throughout your pregnancy, you will • Your ability to have an epidural or
no doubt hear many birth stories – spinal anaesthetic (pain relieving
some good, some bad and others medications into the spine) during
you would rather not have heard! labour, especially if you have
As these stories reveal, each birth is arthritis that affects your spine.
unique and rarely are they perfectly
It is easy to get overwhelmed by the
what the parents imagined.
pressure to have a ‘normal’ vaginal
Towards the end of your pregnancy, birth. However the most important
talk to your rheumatologist, goal at the end of your pregnancy
obstetrician and/or midwife about is for both you and your baby
how your arthritis could potentially to be healthy. Try not to get too
impact on your delivery, such as: preoccupied by the idea of a perfect
birth. Instead, surround yourself with
• The positions you could use during
healthcare professionals who you
labour and delivery. For example,
trust, and keep your focus on that all
there might be some positions
important end goal, a healthy, happy
that might be more comfortable if
baby and mum.
you have difficulties with your hips
or lower back.
• Your ability to deliver your baby
vaginally. Talk to your
• The likelihood of requiring a healthcare
caesarean section. Remember, team about how
while a caesarean section is
more common in women with your arthritis could
rheumatoid arthritis, many women potentially impact on
without arthritis are also advised
not to deliver their babies vaginally.
your baby’s delivery.
A caesarean section may be the
best option for a healthy baby.
Arthritis Australia 17Life with a new baby make it easier if your mobility or
The arrival of your tiny bundle ability to carry your baby is very
limited.
of joy will undoubtedly change
your life forever. Caring for a new • A change table on wheels may
baby is equal parts exciting and make it easy for you to move it
exhausting for all new parents. And, around the house.
as a parent with arthritis, you may • Look for baby wipes and creams
even experience some additional with easy to open lids.
challenges.
• Ask someone to open the nappy
packets for you or open them
Caring for a new baby with scissors as they can be a
It is physically and emotionally challenge to get into with sore
demanding to care for a new baby, hands.
and even more so when you have • Set up a change table that is at
arthritis either as a mum or dad. a height where you don’t need
Here are a few tips that may help: to bend over, or one where you
can even sit while changing your
Nappy changing baby’s nappy.
• Have change stations set up in • While cloth nappies may be
different parts of the house, more environmentally friendly,
with everything you may need disposables tend to be more
to change your baby’s nappy, to absorbent, meaning you won’t
18 Arthritis and pregnancyneed to change them as often. • When your baby is very young, it
They will also save you a few extra might be easier to bathe him/her
loads of washing each week too. in the laundry trough/sink.
If using cloth nappies, look for
ones with Velcro closures to make
Cots, bassinets and high chairs
it quick and easy to change.
• Look for items that are easily
height adjustable, lightweight
Bathing and on wheels to make it easy to
• Look for baths that can be move them around the house.
filled and drained in the sink
or bathtub. Some baths come • Test the clips, release mechanisms
on trolleys that can be wheeled and brakes to ensure they are easy
around. to use.
• If you’re bathing your baby in
a bathtub, look for supports Dressing
or slings that they can lie on. • Look for clothing that is easy to
Remember you will always need put on and take off your baby,
to closely supervise your baby in such as elastic waists and wide
the bath. opening envelope necks. These
Arthritis Australia 19will be easier on sore hands. Avoid • Use a pram caddy and baby bag
snap closures, buttons and zips. to keep all your essentials close
to hand when you are out. Try
• Avoid socks and shoes for your
to keep your baby bag as light
baby if you have sore hands.
as possible. Consider using a
Instead use jumpsuits that cover
backpack instead of a bag that sits
your baby’s feet.
on one shoulder, or hang it off
your pram.
Out and about
• Try different baby carriers and
• Use a lightweight stroller or pram
slings to find one that can help
that is easy to fold, unfold and
you carry your baby without
lift into your car. Test the harness
straining your hands, arms or
to ensure it is easy to clip/unclip
shoulders.
and adjust, and ensure the brakes
are easy to use. Check the height
of the handle and comfort for Ask for, and accept, help
walking. A 15kg pram versus • Organise a network of supportive
a 6kg pram may make all the family and friends who can help
difference. It’s worthwhile testing you when you need it. This will
lots of different prams before be particularly important if you
you buy as sometimes the most have a flare of your arthritis
expensive or popular ones are not symptoms, or even just if you and
necessarily the most user friendly. your baby are having a bad day.
20 Arthritis and pregnancyNew mothers without arthritis tidying up can wait. Rest when
often need a support network too your body is telling you it needs
during the early months of life rest.
with a new baby.
• Try to decide what tasks are a
• If you don’t have a support ‘must do’, what can wait and
network of family and friends, what can be outsourced to family,
investigate external help that may friends or hired help. Prioritise
be available. Ask your obstetrician, the tasks that absolutely need to
midwife, community nurse or GP
get done as well as resting and
about support services that may
enjoying your new baby. Don’t
be available in your area. Cleaners,
push yourself to get non-essential
nannies, au pairs, meal delivery
tasks done.
services or other community-based
supports in your area may be • Consider your own clothing; for
helpful. example can you manage clips on
• Make use of online shopping and maternity bras and tops, or is a
home delivery services. pull down/up version easier?
Listen to your body Taking care of yourself
• Pace yourself and be gentle • It can be a huge adjustment in the
with yourself. If you’re feeling first days, weeks and months with
exhausted, the house chores or your new baby.
Arthritis Australia 21• Most women experience ‘the baby Get advice from your
blues’ in the first days after your healthcare team
baby is born. This is very normal • If you’re struggling to look
and may make you feel teary, after your baby because of pain
irritable and overly sensitive. The or other symptoms, see your
baby blues usually go away after a rheumatologist to talk about your
few days. treatment options.
• If you’re feeling low in mood and • See a physiotherapist or
energy, having trouble sleeping occupational therapist for advice
or eating, feeling scared, sad, about looking after your joints and
hopeless or angry for more than equipment that can make caring
two weeks, seek help. for your baby easier.
• You can talk to your GP, child • Get advice from a child health
health nurse, the Perinatal Anxiety nurse or lactation consultant for
and Depression (PANDA) Helpline ways to make it easier to care for,
(1300 726 306), your partner, and feed, your baby.
friends and family. Getting the
right support and treatment will
help you manage post-natal Breastfeeding and bottle
depression and have you feeling feeding
better sooner. Australian guidelines recommend
exclusive breastfeeding for babies
to around six months of age.
Breastfeeding is then recommended
to continue alongside suitable foods
for infants until 12 months or age
and beyond, for as long as the
mother and child wish.
Whether to breastfeed or not, or
for how long, is a very personal
decision. Even mothers without
arthritis can have issues that can
prevent breastfeeding, or make it
very difficult.
There are usually no physical reasons
that prevent women with arthritis
22 Arthritis and pregnancyfrom breastfeeding, apart from team, including your rheumatologist,
possible discomfort if you and your about your plans for breastfeeding
baby are not positioned correctly so that the best treatment plan, for
during feeding. You can get advice both you and your baby, can be put
on this from your child health nurse into action when your baby is born.
or lactation consultant at your local See the table on page 11 for a
hospital. summary of the safety of arthritis
The choice to either breast or bottle medications during breastfeeding.
feed your baby will depend on many
factors, such as your milk supply, Breastfeeding and joint pain
your baby and the medications you If you decide to breastfeed, here
are taking. are some tips to make it more
comfortable on your sore joints:
Breastfeeding and medications • Find a comfortable position.
Many arthritis medications are safe You might have a supportive
to take during breastfeeding as they chair at home already, or you
do not pass into breast milk, or only might choose to invest in a
in very low levels that are safe for breastfeeding chair, but make sure
the baby. Others can pass into your your neck and back are supported
breast milk and will not be safe for in a comfortable position. New
your baby. Talk to your healthcare babies feed all the time so make
Arthritis Australia 23sure the chair is very comfortable Bottle feeding and joint pain
as you will be spending a lot of Bottle feeding can also cause strain
your day (and night) in it. Some on sore arms, hands, necks and
women find breastfeeding more upper backs. Here are some tips:
comfortable lying on their side, so • Find a comfortable position. Make
you may have to experiment with sure you sit in a comfortable
different positions before you find chair that supports your neck and
what works best for you. back. Use cushions or pillows to
• Breastfeeding pillows are a great bring your baby to a height that’s
way to support your baby, without comfortable for you to hold the
putting strain on your hands, bottle in their mouth.
arms, shoulders and back. • You could also try feeding your
• Seek advice from a lactation baby in a baby carrier, sling or
consultant or child health nurse rocker if it’s difficult holding
if you are finding breastfeeding your baby in your arms for long
difficult or painful. They may be periods.
able to recommend a range of • Look for wider bottles that are
different equipment or aids that more comfortable to hold in your
can make all the difference. hands.
24 Arthritis and pregnancy• Ask your partner, family or friends
who are visiting to help when they
can. It is a good
• Consider asking for help if you idea to have
can’t open the cans of formula or
ask your partner to prepare the an appointment
bottles if you’re going to be alone booked with your
for a long period of time.
rheumatology team
• Ask someone to help you with four to six weeks
washing all the used bottles, or
use a steriliser or dishwasher to after the birth.
clean the bottles.
Post-natal flare If you notice your arthritis symptoms
Just as you’re trying to cope with the worsening in the weeks or months
sleep deprivation, and the physical after the birth, get in touch with
and emotional demands of being a your rheumatologist straight away
new mum, you might also have a for advice about your treatment
flare of your arthritis symptoms. options and make an earlier
appointment than planned.
Many women with arthritis find that
their symptoms return or flare in A physiotherapist, occupational
the months after the baby is born. therapist or child health nurse
Post-natal flares are common, with may also be able to give you some
studies suggesting up to 40% of practical advice about how to look
women with rheumatoid arthritis after your baby during a flare.
experience a flare in the six months Using a baby carrier/sling and other
after giving birth. equipment can make caring for your
baby easier on your joints. See the
This flare can make caring for your
section below for some tips about
newborn extremely challenging. All
caring for a new baby when you
the usual baby-care activities such as
have arthritis.
holding your baby during feeding,
changing nappies, bathing, carrying Most importantly, plan to get extra
and lifting your baby can be nearly help. Have a support crew of family
impossible if you have severe joint and friends on call for extra help if
pain and stiffness. You might also your arthritis flares. Don’t be afraid
feel completely exhausted with to ask for help from your network
arthritis-related fatigue on top of the during this time when you might be
sleep deprivation that comes with struggling with even the most basic
new babies. tasks.
Arthritis Australia 25Seeking support
Who can help? your feelings. You may be eligible
Rheumatologists are doctors who for a Mental Health Care Plan,
specialise in diseases of the joints. via your GP, which will provide
Your doctor will need to refer you subsidised sessions. You can
to a rheumatologist. They may also see a psychologist without
recommend a rheumatologist or needing a referral. Visit
you can contact the Australian www.psychology.org.au
Rheumatology Association to Perinatal Anxiety and Depression
find a rheumatologist at Australia (PANDA) supports
www.rheumatology.org.au
women, men and families across
A rheumatology nurse, if available, Australia affected by anxiety and
can help you understand your depression during pregnancy and
treatments, provide support and refer early parenthood. Visit www.panda.
you to other health professionals. org.au or call the PANDA National
A physiotherapist (physio) can Helpline on 1300 726 306.
use various treatments to keep beyondblue provides information
your joints as flexible, strong and and advice about depression,
pain-free as possible. They will also anxiety, available treatments
show you exercises and pain-relief and where to get help. Visit
techniques to use at home. Visit
www.beyondblue.org.au
www.choosephysio.com.au
Child health nurses are a wealth of
An occupational therapist (OT)
information and support as you learn
can provide advice on how to care
to care for your new baby. Ask your
for your baby without putting strain
on your joints, including suggesting obstetrician or midwife, or contact
equipment and aids that can help. your local community health centre to
Visit www.otaus.com.au find out about services in your area.
Talk to your GP if you are finding Lactation consultants can help you
your feelings and emotions are with any problems you might have
getting in the way of enjoying your with breastfeeding. Find out if your
life. They can suggest ways to cope, local hospital or child health clinic
recommend medications that can provides this service, otherwise you
help or refer you to a psychologist can pay for a private consultation.
who can help you work through Visit www.lcanz.org
26 Arthritis and pregnancyThe Australian Breastfeeding be relevant or approved in Australia.
Association has a helpline 1800 Always check information from the
mum 2 mum (686 268) and web with a trusted member of your
online forum to help you with any healthcare team.
breastfeeding concerns. The Australian Government’s
The Independent Living Centre HealthInsite www.healthinsite.gov.au
has information about aids and is an excellent starting point for web
devices that can help with day-to-day searches, as every site that
activities. Visit www.ilcaustralia.org.au HealthInsite links to has been
or call 1300 885 886. checked for quality and accuracy of
information.
Useful resources
Australian resources
The web can be a useful source of Arthritis Australia’s website for
information and support. However, people living with inflammatory
not everyone who puts information arthritis www.empowered.org.au
on the web is a qualified health has a detailed section on pregnancy,
practitioner. including hearing directly from
Some organisations make unrealistic women with arthritis about their
promises in order to sell their journeys to motherhood.
products. Treatment options and The Australian Rheumatology
practices from overseas may also not Association has a detailed
Arthritis Australia 27document that outlines the most International resources
current evidence about the safety
Arthritis Research UK
of arthritis medications during
Pregnancy and arthritis booklet
pregnancy, available at https://
https://www.arthritisresearchuk.
rheumatology.org.au/ gps/
org/arthritis-information/daily-
documents/ARAPregnancy
life/pregnancy-and-arthritis.aspx
Prescribingnotes29Aug17_000.pdf
Arthritis, pregnancy and the path to Creaky Joints and Global Healthy
parenthood is a book written by Living Foundation
Suzie May, an Australian woman A patient’s guide to family planning with
with arthritis. It shares her experience rheumatic diseases
of having two children while living http://creakyjoints.org/
with rheumatoid arthritis, and the wp-content/uploads/2017/08/
stories of other men and women CreakyJoints_Family-Planning_
from around the world, as they fulfil Patient_Guidelines_2017.pdf
their goal of becoming parents,
Please keep in mind that some issues
alongside managing their arthritis.
and treatments from overseas may
This practical guide can help you
not be relevant in Australia.
understand the potential challenges
you may face and give you
strategies to overcome them.
The book is available at
www.arthritisaustralia.com.au
28 Arthritis and pregnancyGlossary
Ankylosing A type of inflammatory arthritis that mainly affects the spine,
spondylitis (AS) causing pain and stiffness.
Antiphospholipid A blood disorder that can lead to an increased risk of having
syndrome (APS) a blood clot and problems with pregnancy. It is caused by the
immune system producing abnormal antibodies (protein), making
the blood more likely to clot.
Biological Biological disease-modifying anti-rheumatic drugs, often called
DMARD biologics. These medications block specific substances in the
(bDMARD) immune system to reduce inflammation, pain and damage to the
joints. Biologics may be used to treat some types of inflammatory
arthritis.
Conceive To become pregnant.
Contraception Treatments and devices that both men and women can use to
help prevent pregnancy, such as condoms, contraceptive pill,
injections and implants.
DMARD Disease-modifying anti-rheumatic drugs. DMARDs act on
the immune system to reduce inflammation, pain and joint
damage. These medications can be used to treat some types of
inflammatory arthritis, such as rheumatoid arthritis.
Inflammatory These are types of arthritis that affect your immune system. Your
arthritis body’s immune system starts attacking healthy tissues, which can
cause pain, stiffness and joint damage. Types of inflammatory
arthritis include rheumatoid arthritis, ankylosing spondylitis and
psoriatic arthritis.
Fertility The ability to conceive a child.
Flare A period of worsening arthritis symptoms and disease activity.
GP A general practitioner (GP) is trained in medicine and treats
people for general health problems and non-emergency medical
care. They are usually the first person you go to if you have a
health problem.
Immune system The body’s defence system that fights infections and illnesses to
keep you healthy.
Low birth weight A baby born weighing less than 2.5kg.
Arthritis Australia 29Lupus An auto-immune condition that affects skin, joints, kidneys,
blood vessels and/or other parts of the body.
Miscarriage The loss of a baby before 20 weeks of pregnancy.
NSAIDs Non-steroidal anti-inflammatory drugs. These medicines reduce
inflammation, joint swelling, pain and stiffness.
Obstetrician A doctor who specialises in looking after women during
pregnancy, childbirth and after birth.
Placenta The organ that is attached to the lining of your uterus (womb)
during pregnancy. It provides oxygen and nutrients to your
growing baby and removes waste products from your baby’s
blood.
Post-natal Anxiety or depression that begins sometime in the year after
depression birth. It can begin suddenly after birth or appear gradually in the
weeks or months during the first year after birth.
Pre-eclampsia A serious condition that can occur during pregnancy, causing
high blood pressure and/or protein in your blood.
Premature A premature birth is when a baby is born before 37 weeks.
Psoriatic arthritis A type of inflammatory arthritis that can affect people with
(PsA) psoriasis, and causes joint pain, swelling and stiffness.
Remission A period where symptoms improve or completely disappear.
Rheumatoid A type of inflammatory arthritis that causes joint pain and
arthritis (RA) swelling.
Rheumatologist A doctor who specialises in diagnosis and treatment of joint,
muscle and bone disorders.
Rheumatology Nurses with specialist knowledge and training in arthritis. They
nurse work with rheumatologists and can provide you with education,
support and advice.
Supplement Substances you eat or drink to provide extra vitamins, minerals
or herbs to your diet. They may be capsules, tablets, liquids or
powders.
TNF inhibitor These medications are a type of biological DMARD. They work by
(TNFi) blocking a substance called Tumour Necrosis Factor (TNF). These
may be used to treat some types of inflammatory arthritis.
Vaccination Provide protection against diseases. Are usually given by
injections (needles) into your arm or leg.
30 Arthritis and pregnancyMy contact details
My name:
Telephone:
My GP
Name:
Telephone:
My specialist
Name:
Telephone:
My support team
Name:
Telephone:
Name:
Telephone:
My medicines
Name Dosage Instructions
Arthritis Australia 31Arthritis Australia
Arthritis Australia is a not-for-profit organisation that provides support and
information for all Australians affected by arthritis.
Arthritis Infoline: 1800 011 041 www.arthritisaustralia.com.au
Arthritis ACT Arthritis South Australia
Building 18 170 Hayden Drive 118-124 Richmond Road
Bruce ACT 2617 Marleston SA 5033
PO Box 908 Belconnen ACT 2616
Arthritis Tasmania
Arthritis New South Wales 19A Main Road
Unit 1.15/32 Delhi Road Moonah TAS 7009
North Ryde NSW 2113 PO Box 780 Moonah TAS 7009
Locked Bag 2216 North Ryde NSW 1670
Arthritis Western Australia
Arthritis Northern Territory 17 Lemnos Street
Shop 18, Rapid Creek Business Village Shenton Park WA 6008
48 Trower Road, Millner NT 0810 PO Box 34 Wembley WA 6913
PO Box 452 Nightcliff NT 0814
Arthritis Queensland
1 Cartwright Street
Windsor QLD 4030
PO Box 2121 Windsor QLD 4030
Arthritis Australia Level 2, 255 Broadway Glebe NSW 2037
Mail: PO Box 550 Broadway NSW 2007
Phone: 02 9518 4441 Fax: 02 9518 4011
Email: info@arthritisaustralia.com.au
Web: www.arthritisaustralia.com.au
Arthritis Infoline: 1800 011 041 ISBN: 978-0-9923052-9-1You can also read
