There’s a lot we still don’t know.
If you have a chronic illness, you know that it can impact a lot of your decision making. Things that might not have even been considerations for your peers could require long term planning for you, and that can prove exhausting, especially if your illness is inconsistent, symptom-wise.
Rheumatoid arthritis (RA) is an autoimmune disorder in which the immune system attacks the tissue, resulting in inflammation in the joints, causing pain, deformation and immobility. A recent study of children whose mothers have RA suggests that they might be at increased risk of developing RA as well, in addition to other health conditions, such as thyroid disease and epilepsy.
The majority of those with RA are cisgender women of childbearing age. There’s some evidence that RA is related to hormones, since it looks very different in men and women (although there could also be environmental factors involved, such as infections, that trigger people who are already at risk). For example, women who breastfeed seem less likely to get RA. RA sometimes goes into remission (are symptom free) while you’re pregnant, but resurfaces after you give birth.
The aforementioned study, performed in Denmark for a period that exceeded 25 years, also revealed that babies born to people with RA were more likely to be delivered via c-section, which makes sense, considering the symptoms of RA, and the fact that while many who have it go into remission while pregnant, not everyone does.
RA may or may not impact your ability to get pregnant or stay that way — it’s unclear. In addition to pain, and the low sex drive that often results from it, sex might not happen often enough to result in pregnancy (although sex can help with pain and well-being for people with arthritis of all types). You also might experience inconsistent ovulation.
Folks might wait until they are in remission and feeling good to start trying for a baby. This could be one reason why the babies of RA mothers tend to be of lower birth weight, which is linked to women of advanced maternal age who give birth.
The study isn’t conclusive in terms of why children whose mothers have RA also have it, and might also develop other health problems, and doctors aren’t entirely sure how much weight to put on it, since the sample size, as science goes, is pretty small. But if you have RA, or any chronic illness with a genetic component for that matter, does that change how you think about your reproductive health?
A, who’s 26 and blogs at My Battle with RA, was diagnosed when she was 20, after four years of scrambling to figure out what was going on. For her, there’s never been any question that RA has a hormonal component, she reports that her symptoms are almost always worse right before her period. Her mother also has RA, but A didn’t know that until she was in her teens. “There’s a little resentment there,” she said. “Little kids don’t understand why mom has to be flakey.”
Before she was diagnosed, A really wanted to have kids. Since then, though, she’s changed her mind. “I think the RA is definitely a major reason, because now I look back on my life and I see all of the ways my mom missed out on my childhood.”
There are genetic markers for RA, but no prenatal testing is available. If you have RA and you do decide to get pregnant, your doctor (you should be seeing a rheumatologist) will work up a treatment plan for you which will probably include figuring out how to manage you RA during pregnancy, and decreasing your medications or advising that you stop taking them altogether, depending on where you are in terms of symptoms. Drugs such as methotrexate can not only cause birth defects, but they also take a long time (up to 2 years) to leave the body completely.
Mariah Leach is the author of The RA Pregnancy Chronicles, a blog at RheumatoidArthritis.net. Leach stopped taking her medications before she got married so she and her fiance could start trying to get pregnant after their wedding. In addition to the pain she felt, she writes that “It was also scary to lose the sense of stability I had fought so hard to regain during the years of searching for an effective treatment.” She urges folks with RA who are trying to conceive to be patient, and no matter what, not to be afraid to lean on one’s partner for support.