I’m pregnant and I have ankylosing spondylitis. Are there any risks involved for my baby?
Fortunately ankylosing spondylitis does not seem to impact fertility or the developing baby. It does not lead to increased risk of miscarriage, stillbirth, or premature labor. As a general rule, women with ankylosing spondylitis can expect to have healthy children of a normal birth weight.
What do I need to know about delivery in AS?
Women with ankylosing spondylitis are more likely to have Caesarean section, though this is not necessary in all cases. One study found a Caesarean section rate of 58%, much higher than the general population. Impaired movement in the hip joint might decrease the change of a successful vaginal delivery, but it does not eliminate it; for example, women with total hip replacement (and no joint mobility) can have normal vaginal deliveries.
Ankylosing spondylitis also may make an epidural difficult or impossible, though again, not in all patients. This procedure is the most common way to reduce pain in both Cesarean section and vaginal births. An individual with AS may need to undergo general anesthesia for a Cesarean section or alternate pain control for an attempted vaginal birth. It may be advisable to have an X-ray of the lower spine performed prior to a planned pregnancy so that doctors have a better idea of what to expect. For example, an anesthesiologist might be willing to perform an epidural on a women with ankylosing spondylitis if he has verifiable evidence that her AS is not advanced, and he knows what to look for when preparing for the epidural.
Will my symptoms increase or decrease during pregnancy? What about after delivery?
About a third of women with ankylosing spondylitis experience increased symptoms during pregnancy. Another third report no change in symptoms, and a final third show decreased symptoms. Women with predominant pain in the hip and spine are more likely to have increased symptoms during pregnancy; women with joint involvement in the shoulders, knees, and other extremities are more likely to see their symptoms improve. Interestingly, improvements in symptoms may be more likely when a woman is pregnant with a female versus a male.
Roughly 2/3 of patients with ankylosing spondylitis can expect a flare of disease activity after giving birth. A women is more likely to flare postpartum if she as active uncontrolled disease at the time of conception. About a fifth of women are first diagnosed with ankylosing spondylitis symptoms within six months of giving birth.
Is there anything I need to do before trying to conceive?
It’s important for women with ankylosing spondylitis to work closely with their doctors in their conception planning. It may be advisable for a woman to wait to conceive until her disease is under control.
Women whose disease is active during pregnancy may need to alter their treatment regimen for the safety of their unborn children. Some medications taken by women with AS are dangerous to the developing fetus and need to be stopped before conception. Some, such as methotrexate, should be stopped for several months before conceiving, to prevent possible birth defects. Others, like sulfasalazine, appear to be safe for the developing fetus. Most non-steroidal anti-inflammatory drugs like ibuprofen (Advil) are thought to be safe during the first part of pregnancy, though they may have adverse effects if given in the last eight weeks of pregnancy. Other drugs, like etanercept (enbrel), have been found safe in animal studies, but have not been used in pregnancy in humans for as long as older medications. Interarticular steroid injections may be a safe option for many women. You should talk closely with your doctor on a case by case basis about what medications you should take prior to conception and at all phases of your pregnancy. In some cases it may be worthwhile to continue a medication, even if this is not 100% risk free.
Questions for your doctor
- If I am trying to conceive, do I need to alter any of my medications?
- Is an epidural possible with my AS? Should I get a current x-ray of the spine before conceiving?
- Is there anything I can do to reduce my risk of a postpartum flare?
About the Author
Ruth J. Hickman, MD, is a freelance health, science, and medical writer. She specializes in writing about medical topics for the lay public and for health science students. She can be reached at [email protected] or through her website: ruthjhickmanmd.com.