Pregnancy
In addition to consulting a physician regarding pregnancy-safe medications, patients with rheumatic diseases should consider other aspects of health and well-being, the experts emphasized.
Ms. Gillett’s recommendations focused on pain management. “Learn how to protect your joints, before you have the baby,” she said. “It changes over time; it changes over the course of your disease—whether you’re pregnant or not. But talk to your doctor about the pain that you’re having, things that you can do and ask for a referral to [an] occupational therapist or a hand therapist or a physical therapist. … I highly recommend you ask your doctor.”
A visit to an occupational therapist or physical therapist may also be warranted because pregnancy can alter how patients complete daily tasks as their body changes and center of mass shifts. These professionals can also help with strategies after the baby arrives. Example: Occupational therapists can “show you how to avoid putting your joints in a position that may cause further inflammation and swelling,” Ms. Gillett said.
Also, good sleep and exercise or physical activity routines are important to develop during pregnancy, both for pain management and overall health.
“One key thing that I want to make clear is that, as a woman living with rheumatic disease, you do actually have some control over how your pregnancy goes,” said Dr. Clowse. “The key to that is planning.”
Post-Pregnancy & Life with a Newborn
Ms. Leach was 25 when she was diagnosed with rheumatoid arthritis, and all three of her children—the oldest of whom is 9—were conceived after her diagnosis.
“Because there wasn’t much data available 10 years ago and no one was talking about this, my first pregnancy was completely unmedicated. The postpartum flare made breastfeeding extremely difficult, and I was advised to stop breastfeeding and restart my medication,” she said.
By Ms. Leach’s third pregnancy, she was able to stay on her biologic treatment, experienced virtually no postpartum flare and was able to make her own breastfeeding choices.
“I think it’s really important to know that you do not have to choose between your own body and your baby,” said Dr. Clowse. “Almost every one of our medications is compatible with breastfeeding.”
Ms. Leach, given the range of experiences she has had raising her children, including her 7-year-old and 3-year-old, also shared her best strategies for parenting.
