At the point of their arthritis diagnosis, for female patients, motherhood can feel like a faraway priority – a distant hope diminished by the complex care which their condition requires. But the launch of an exciting new social media campaign, #MaybeBaby, is demonstrating that by encouraging family planning discourse at an early stage between the patient and healthcare professional, nothing has to be off the table.
For rheumatology patients, the reality of what lies ahead following the discovery of their condition may rarely enter their mind – distracted and directing their focus instead on the daily challenges and painful obstacles which the condition poses. Or perhaps the sheer overwhelming impact of their diagnosis may act as a deterrent upon their willingness to discuss their future; prematurely succumbing to the perception that they can no longer achieve some of the things which they had hoped for, such as travelling, studying or starting a family.
It’s time to help our patients realise that they don’t have to compromise – and that the earlier that their concerns come to light, the greater the chance that their hoped-for future will begin to seem more feasible.
Healthcare professionals are in an invaluable position for breaking down conversational barriers and encouraging individuals to open up a channel of discussion in which their personal options can be considered. This is especially relevant for younger female patients who will benefit from discussing their future plans for motherhood at an early stage so that the appropriate measures can be actioned, and the necessary education garnered.
The patient should be urged to share their pregnancy plans with their doctor or rheumatology nurse specialist before conception, particularly because some of the drugs they’re likely to be taking for arthritis may need to be changed. This way, their chances of having a safe pregnancy and a healthy baby will be greatly bolstered.
Armed with the intent to both promote the significance of, and mobilise the discussion of, early family planning in rheumatology, a major social media campaign has been launched.
A non-branded awareness campaign that fuels a social media conversation has been sparked to prompt young women with rheumatological conditions to talk about (and ask for) treatment that will allow them to continue to stay in control of their disease, and still give them the option to become a mum in the future.
The campaign is set to help women have an informed discussion with their healthcare professional earlier, to jointly agree the most appropriate plan that will keep the woman’s motherhood options open. The ripple effect will lead to the cultivation of a social movement among young women to help them understand that they don’t have to compromise their future – including their motherhood options.
By being provided with the information and tools to help them have conversations with their healthcare professional earlier, their fear will be replaced with a sense of empowerment instead.
Diagnosis doesn’t need to make a difference, options still exist – #MaybeBaby is filled with possibility.
For more information, visit www.arthursplace.co.uk/maybebaby.
A Plan of Action
Versus Arthritis helps NIHR present the family planning questions which will likely arise from your female arthritis patients once the discussion has been opened up – and the necessary guidance which you can equip them with through your answers.
When is the Best Time for your Patient to Have a Baby?
It’s better for your arthritis patient to try for a baby while they’re in a good phase with their arthritis so that the drugs which they need to take are reduced. Most women with lupus who want to become pregnant should do so during a quiet phase (remission).
If they’re over 35 years old it may be harder to get pregnant, and if they wait until they’re over 40 they may be more likely to miscarry and there will be a greater risk of having a baby with a condition such as Down’s syndrome. These risks are not affected by whether the patient has arthritis.
Anyone trying for a baby should stop smoking to reduce the chance of having a small baby (due to restricted growth) and also reduce the risk of cot death. They should minimise the amount of alcohol they drink and not take any recreational drugs.
If your patient is overweight it’ll be harder for them to become pregnant and could make it more likely for them to develop diabetes during pregnancy. They should subsequently be encouraged to lose some weight before they get pregnant, which will help their joints as well.
Should they Stop all of their Drugs Before Becoming Pregnant?
The patient shouldn’t stop taking prescribed drugs without talking to their doctor first. Many drugs can be continued safely in pregnancy, and the aim is to prescribe them the safest combination of drugs at the lowest reasonable dose that will keep their arthritis under control. This approach minimises the risk of the drugs causing problems with the patient’s pregnancy. Some drugs may have to be stopped before your patient gets pregnant, for example they shouldn’t become pregnant while they’re on methotrexate, cyclophosphamide or leflunomide as they can harm the unborn baby.
However, there are other drugs available for women with any of the chronic inflammatory diseases, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Crohn’s disease, to take throughout their reproductive health journey.
It should also be considered that some recent studies suggest that non-steroidal anti-inflammatory drugs (NSAIDs) could make it more difficult to conceive and, if taken around the time of conception, may increase the risk of miscarriage, so you might want to discuss this risk with them.
Paracetamol, taken in normal doses, hasn’t been linked with either of these problems.
Topping the drugs could make their arthritis worse, but you will be able to advise them on the drugs that they’ll be able to take. Other pain relief treatments can be considered, such as physiotherapy and acupuncture.
What Conception and Fertility Problems are Possible through Arthritis?
The patient’s fertility isn’t likely to be affected by arthritis, but it may take longer for them to become pregnant if the arthritis is active. An increased rate of miscarriage is seen in some patients with lupus and antiphospholipid syndrome.
In other patients, the disease being active and taking certain drugs (such as cyclophosphamide) are the main risk factors that make it more difficult to get pregnant. This means that it’s very important to plan to get pregnant at times when the condition is under control and stop certain harmful drugs in advance.
Will the Pregnancy Affect the Patient’s Arthritis?
Most women get aches and pains, particularly backache, during pregnancy. The effect of pregnancy on arthritis varies depending on the type:
• Most women with rheumatoid arthritis will be free of flare-ups during pregnancy, although they’ll probably return after the baby is born
• If they have osteoarthritis, particularly of the knee or hip, the increase in their weight as the baby grows may cause problems
• Other disorders, such as ankylosing spondylitis, may improve or become worse – there’s no consistent pattern
Will the Arthritis Affect their Pregnancy?
Apart from lupus, most types of arthritis don’t harm the baby or increase the risk of problems during pregnancy. The patient should be aware about the possible effects of the drugs they take while pregnant, as they can sometimes affect the pregnancy.
The Expert Insight
The best advice is always to plan in advance to conceive at a time when the disease is controlled on appropriate medication throughout pregnancy.
Dr Ian Giles, a Consultant in Rheumatology at University College London Hospital, said, ‘Many forms of inflammatory arthritis do get better in pregnancy, but the risks of (the disease flaring up) are slightly different depending on the type of arthritis.’
He continued that by maintaining effective treatments with a reduced side-effect profile, ‘we would hopefully reduce the risk of the disease flaring postpartum, but unfortunately we don’t have a really good predictive test for either disease flare or disease remission in pregnancy.’