Pregnancy.

Whether you suffer from an autoimmune disease or not, at some point in your life, the moment might come for you to thinking about starting your own family. If you are considering it and you think it is the right time, it is necessary to discuss the subject with your rheumatologist and your care team before trying to have a child. Some things need to be planned to ensure that your pregnancy will go well and is sage for you and your child to come. If you are a man, there are also some precautions to take before thinking about starting your family. 

First and foremost, you will need to ask yourself some basic questions such as: what is my condition right now? Is it a good time to stop or change some of my medications? Do I feel able to take care of a baby day and night even if my arthritis is active? Is breastfeeding essential for me or will I give my child formula to resume my treatment right after delivery? Can my relatives and friends bring me sufficient physical and psychological support? If I am a man and I want to conceive a child, am I willing to change my treatment and risk having arthritis flares?

We understand how difficult this topic is and how it can create uncertainty. We do not intend to dissuade you from becoming parents. Arthritis, as such, is not a contraindication to a child's conception but your treatments can be. Therefore, a frank discussion of the issues and the reality of becoming parents is essential for you to be able to enjoy this moment in your life as it should be for all parents.

First, your specialist will discuss the pros and cons with you. You will have to stop taking certain medications, regardless of your gender. Treatments that may harm the baby are Methotrexate and Leflunomide (Arava). These treatments can be toxic to the embryo and cause malformations. Other medications can have an adverse effect on your unborn baby, but are less frequently used. Still, always confirm with your doctor whether you should stop them or not. A weaning of at least three months will be necessary before attempting to conceive a child. During this time, effective contraception should be used, such as birth control pills and condoms with spermicide. Some treatments may replace those you need to stop. Their risks for the child to come are virtually nonexistent. These drugs are Azathioprine (Imuran), Salazopyrine (Sulfasalazine), and Hydroxychloroquine (Plaquenil). In humans, Salazopyrin can decrease the number of spermatozoa. If after six months of testing, your partner is still not pregnant, a seminogram can be considered.

Non-steroidal anti-inflammatory drugs (NSAIDs) should also be discontinued or used only as needed, as they affect the fetus at all stages of pregnancy. According to CMAJ (Journal of the Canadian Medical Association), the risk of spontaneous abortion increases 2.4 times if NSAIDs are taken at conception or just after conception. In the first trimester, the risk of congenital malformations also increases. Later, in the second and third trimesters, NSAIDs can lead to malformations of the kidneys and arteries of the unborn child and there is a risk of fetal toxicity that can cause death. It is therefore best to avoid them as much as possible, especially during the third trimester. Discuss with your doctor the risks of occasional intake and medications to be preferred in this context. In terms of breastfeeding, NSAIDs are poorly secreted in breast milk and the safest ones are Ibuprofen, Naproxen, Diclofenac and Flurbiprofen.  

Glucocorticosteroids given at the lowest possible dose may be an option for people with active arthritis in pregnancy or in men who discontinue DMARDs with contraindications to NSAIDs, experiencing pain thrusts during all three months of weaning before attempting to conceive a child.

 

Acetaminophen is the analgesic of choice in pregnancy as it is not associated with any malformation in the fetus.

In the case of biological therapy, some are riskier than others. Following to the discussion with their rheumatologist, some women will choose to continue their treatment. For men, it is not necessary to stop this kind of medication. The experience we currently have with TNF-blocking drugs in pregnancy is reassuring. Pregnancies go well and children are healthy.

 

Here are some points to remember after delivery. Do not use live attenuated vaccines in a baby under six months of age whose mother has been exposed to a biological agent during pregnancy. Live attenuated vaccines in children are used against rotavirus diarrhea, measles, rubella, mumps and varicella. Do not forget to mention to the doctor or pediatrician who will follow your child after birth that you have been treated with a biological agent during your pregnancy, so that he follows the recommendations to that effect.

Here are some links that can help you in your decision making before conceiving a child. The CAPA website and Mother to Baby are sites with truthful information chained by doctors who review the content:

-For CAPA web site you can follow this link.

-For Mother to baby web site you canfollow this link.

-You can also read about pregnancy with rheumatoid arthritis on the Rheumatoidarthritis.net following that link.

-The next website is Irish but the explanatory videos are very helpful for all pregnant women or thinking of becoming pregnant. You can watch them by following this link.

-If you are breastfeeding and have concerns about the medications you are taking, you can search the LactMed TOXNET site for the answers to your questions by entering the name of your treatment in their search engine. You can follow this link. You can also search in the InfantRisk Center website following that link.

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© 2016 Institut de Rhumatologie de Montréal

révision Septembre 2018.

L'IRM remercie Abbvie, Amgen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi et UCB pour leur support.

Une réalisation