MARRIAGE, PREGNANCY AND LACTATION AND RA


Rheumatoid arthritis, affects females more than males, often in their reproductive period. Many female patients are either not married or if married have not completed their families. The question of marriage, pregnancy and lactation, therefore, assumes great significance. This issue is discussed in this communication.

Can / Should a patient of RA marry ?
There is no reason why a patient of RA, whether a female or a male, cannot marry. It is however absolutely essential that the prospective partner and his / her family are fully in the know of the affliction, so that therapy can be continued without any difficulty.
The patients and their families naturally have many questions, reservations and misgivings. We are always willing to sit and discuss these matters with the families concerned.

Is pregnancy contraindicated in patients of RA ?
There is no contraindication to pregnancy in patients suffering from rheumatoid arthritis. There is a tendency for RA to ameliorate during pregnancy but this is not always so. Further after pregnancy there is flare up of the disease. It is therefore advisable to avoid pregnancy while the disease is more than moderately active.

Can the patients continue all the arthritis medicines during pregnancy ?
No. Not all medicines are safe during pregnancy. Amongst DMARD, only hydroxychloroquine, sulfasalazine and corticosteroid are safe and can be continued uninterrupted. Amongst these corticosteroid is the safest.
Other drugs like methotrexate, cyclophosphamide, leflunomide must be discontinued for at least 2 months, preferably six months before planning pregnancy. In case of leflunomide blood levels of the drug should be estimated to confirm safe levels. Leflunomide levels can be brought down with oral cholestyramine treatment. All these drugs have an adverse effect on the developing foetus. A couple planning pregnancy must discuss this with the treating physician / rheumatologist.

What happens if a lady becomes pregnant on above medicines ?
Termination of pregnancy is advised as there is a high risk of damage to growing foetus (foetal malformations)

What about NSAIDs ?
NSAID’s are generally safe during pregnancy. They should be discontinued 4 weeks (or earlier) before the due date of delivery. This is to prevent excessive bleeding following delivery. During this period patient can be managed on paracetamol or even a small dose of corticosteroid or intra-articular corticosteroids if necessary.

Can an RA patient feed her baby ?
Yes. Breast feeding is permitted with following precautions.
To use short acting NSAIDs (your doctor will guide you). The medication should be taken just before starting the breast feed. Next feed should be after a gap of four hours. This diminishes the drug concentration in the breast milk.
During lactation amongst DMARDs, sulfasalazine can be continued with caution. The safest drug is corticosteroid. It is advisable to finish pregnancies as soon as disease is under control. This avoids pregnancy during advanced age and also with increased joint damage and disability.

Can a female RA patient take oral contraceptives ?
There is no contraindication to the use of oral contraceptives (OC). There is a suggestion that OC may have a beneficial effect on the disease.

Will the children of an RA patient get RA ?
As explained in an earlier communication. RA is not an inherited disorder. What is “inherited” is susceptibility to disease development. Familial cases of RA are known but the incidence is not such as to advise against having children.