It’s best to discuss your pregnancy plans with your doctor or rheumatology nurse specialist before conception, particularly because some of the drugs you’re likely to be taking for your arthritis may need to be changed.
This way, you'll improve your chances of having a safe pregnancy and a healthy baby.
When is the best time to have a baby?
It’s better to try for a baby while you're in a good phase with your arthritis so you can reduce the drugs you need to take. Most women with lupus who want to become pregnant should do so during a quiet phase (remission).
If you're over 35 years old it may be harder to get pregnant. If you wait until you're over 40 you may be more likely to miscarry and there’ll be a greater risk of having a baby with a condition such as Down's syndrome. These risks are not affected by whether you have 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. You should minimise the amount of alcohol you drink and not take any recreational drugs.
If you're overweight it’ll be harder for you to become pregnant and could make you more likely to develop diabetes during pregnancy. So try to lose some weight before you get pregnant, which will help your joints as well.
Should I stop all my drugs before becoming pregnant?
You shouldn’t stop taking prescribed drugs without talking to your doctor first. Many drugs can be continued safely in pregnancy. Your doctor will aim to prescribe the safest combination of drugs at the lowest reasonable dose that will keep your arthritis under control. This approach minimises the risk of the drugs causing problems with your pregnancy.
Some drugs may have to be stopped before you get pregnant, for example you shouldn’t become pregnant while you’re on methotrexate, cyclophosphamide or leflunomide as they can harm the unborn baby.
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 your doctor. Paracetamol, taken in normal doses, hasn't been linked with either of these problems.
Stopping your drugs could make your arthritis worse, but your doctor will be able to advise you on drugs that you'll be able to take. You may also be able to use other pain-relief treatments, such as physiotherapy and acupuncture.
Conception and fertility problems
Your fertility isn’t likely to be affected by arthritis, but it may take longer for you to become pregnant if your arthritis is active. An increased rate of miscarriage is seen in some patients with lupus and antiphospholipid syndrome (APS).
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 it’s very important to plan to get pregnant at times when your condition is under control and stop certain harmful drugs in advance.
Does it matter if the father is taking drugs for arthritis?
Some arthritis drugs can cause problems in men trying to father a child. For instance, cyclophosphamide can reduce fertility in men. Doctors advise men to stop this drug three months before trying to father a child.
Many doctors used to advise men to stop taking sulfasalazine and methotrexate before trying to father a child. Current guidelines, however, advise that men do not need to stop sulfasalazine or methotrexate unless they have been trying to father a child for more than one year, and have been unsuccessful.
Read more about drugs, pregnancy and breastfeeding.