Pregnancy and Arthritis.

Deciding to have a baby

Controlling the arthritis

Health care team

Follow your treatment plan

You're probably already following a treatment plan for your arthritis. Once you become pregnant, you and your doctor may have to change some parts of this plan slightly. As a pregnant woman with arthritis, your plan should include:

• arthritis medicines: know what arthritis medicines you're taking and how they will affect your baby
• exercise: to keep your muscles strong and your joints flexible
• diet: eat a balanced diet
• joint protection: learn ways to ease joint pain and to reduce stress on your joints
• stress management: to help ease the emotional ups and downs of pregnancy.

Medications

You've probably wondered whether you should continue taking your arthritis medicines. While it would be ideal to be off all medicines during pregnancy, this is not always possible. Talk to your doctors about the medicines you're taking and which ones are safe to take while you're pregnant. Some medicines are used more often than others during pregnancy, and your doctor may prescribe medicines other than those listed below. Some medicines just haven't been used enough to know whether or not they'll cause problems to your baby during pregnancy. The most important concern, of course, is keeping you and your baby as healthy as possible.

Discuss any medicines you use--either prescription or over-the-counter--with your doctor(s). If you must take medicines during your pregnancy, your doctor will give you the lowest possible dose and will monitor the effect of the medicine on you and the baby. Do not start or stop taking any prescription or over-the-counter medicines without first contacting your doctor.

Taking medicines while breast-feeding

Any medicines you take may be passed to your baby through breast milk. Here. are some tips to consider if you intend to breast feed.

• Any medicines you take may be passed to your baby through breast milk. Here. are some tips to consider if you intend to breast feed.
• Talk to your doctors and to your baby's doctor about your medicines and their possible effects on your baby.
• Never take any prescription or over-the-counter medicines without first checking with your doctor or pharmacist.
• Take your medicines after the baby's morning feeding, so less medicine will be passed through your milk.

Exercise

You probably already have an exercise program to follow for your arthritis. While you'll want to continue exercising to keep your joints in their best condition, you'll also want to make sure the exercises don't harm your baby. Discuss your exercise program with your doctors before you begin, especially if you have:

• heart problems
• phlebitis (inflammation of the veins, usually in the legs)
• a serious infection
• severe high blood pressure
• high risk for premature labor
• incompetent cervix (a problem that could cause your baby to be born prematurely)
• any bleeding from the uterus
• any problems with the fetus

If your arthritis improves during your pregnancy, you may wish to exercise more than usual.

Exercise tips:

• Practice range-of-motion exercises to help keep your joints flexible.
• Exercise to strengthen your muscles--especially the quadriceps muscles (the large muscles above your knees)--before you become pregnant. Strong muscles will provide better support for your joints. Talk to your obstetrician about the types and amount of muscle strengthening (isometric) exercise you should do. Too much of the wrong type of exercise could reduce the amount of blood flowing to the baby, which can cause problems.
• Try walking or swimming. These are general exercises that help keep your muscles strong, increase your endurance, and are generally safe for pregnant women.

Diet

Good nutrition is very important for your health and for your baby's health. You should eat a balanced diet and practice good eating habits before, during, and after your pregnancy, especially if you are breast-feeding. A dietitian, nutritionist, or other health care worker can help you plan a balanced diet.

Arthritis may cause eating problems, due to:

• a reduced amount of saliva (as in Sjogren's syndrome)
• tooth problems
• mouth sores
• problems with food sticking in your esophagus
• trouble opening your mouth due to jaw pain

Also, joint pain may make it difficult to prepare meals, so you may be less likely to eat a balanced diet. If you're taking prednisone, you may need a special diet to help avoid high blood sugar which may be caused by the medication. Discuss these problems with your doctor.

Some possible problems and solutions associated with pregnancy and diet are discussed here.

Problem 1. Weight gain or weight loss

Gaining too much weight will put more stress on your joints. The extra weight of pregnancy can make this problem worse. But if you do not gain enough weight, you and your baby may not be getting enough nutrients you both needs to stay healthy.

Most doctors suggest you gain between 20-30 pounds during pregnancy. To do this, you must balance diet and exercise. Here are some questions you should consider:

• How much and what types of exercise can by joints handle?
• How long can I exercise at one time?
• Are my arthritis or arthritis medicines decreasing my appetite and causing me to lose weight?
• Am I taking any medications, such as prednisone, that may increase my appetite and cause me to gain weight?
• Is emotional stress causing me to eat too little or too much?

Your obstetrician or dietitian can help you plan a diet that takes these factors into consideration. If your arthritis, for instance, prevents you from getting as much exercise as you would like, then you will not need as many calories as someone who is more physically active. But you still will need to pay close attention to your diet, to make sure you get enough vitamins and minerals.

Problem 2. Nausea and vomiting

Nausea and vomiting can lead to problems that could affect you and your baby.

To reduce nausea:

• Eat small, frequent meals.
• Eat slowly and chew food thoroughly.
• Avoid greasy, fried foods.
• Eat toast or crackers when you get up in the morning.
• Avoid drinks that might upset your stomach, such as coffee and fruit juices.
• Talk to your doctor about your arthritis medicines and how they might be affecting your nausea.

Problem 3. Heartburn

Heartburn usually gets worse as your uterus enlarges and pushes up on your stomach.

Talk to your doctor about this and how your arthritis medicines might be affecting your heartburn.

To reduce heartburn:

• Eat small, frequent meals
• Decrease caffeine in your diet
• Avoid fried, fatty, and spicy foods
• Avoid carbonated drinks, such as soda
• Raise the head of your bed by placing 6" blocks beneath it
• If you use antacid, choose one which is low in sodium

Problem 4. Constipation

Bowels may slow down during pregnancy and cause constipation. Some forms of arthritis, such as scleroderma, also cause bowel changes.

Contact your doctor immediately if you are having bloating, gas, diarrhea, or constipation problems beyond what your doctor thinks is normal for you.

To relieve constipation:

• Eat high-fiber foods (whole-grain breads, fresh fruits and vegetables, cereals with bran, beans such as kidney and pinto)
• Drink 6-8 glasses of water daily
• Exercise (such as walking or swimming)
• Try a high fiber laxative, such as Metamucil

Joint protection

The extra weight of pregnancy may make your joints hurt more. To avoid further damage to your joints, it's important to learn ways to protect your joints from extra stress and strain. Here are some ways to do this.

• Avoid pain-relief medicines when possible. Talk to your doctor before you use any pain relief medicines and ask about exercises, heat and cold applications, and other things you can do to reduce pain.
• Use hot or cold packs on your joints. This is safe to continue throughout your pregnancy.
• Use splints. They may be especially helpful for your hands and knees. Talk to your occupational therapist or other health care worker about having splints made for you.
• Rest whenever possible. This can help relieve pain in your weight bearing joints, such as your hips, knees, ankles, and feet.
• Try relaxation exercises, such as biofeedback or visual imagery.
• Wear comfortable shoes (such as jogging shoes) that give you good support. Shoes should have a 1" to 1 1/4" heel, good arch support, roomy toe box, and firm heel-counter. Lace-up or velcro-closure shoes provide the most support.
• Practice good posture and gait at all times.
• Sleep on a firm, supportive mattress to reduce muscle spasms.
• Ask your obstetrician about using support hosiery to reduce fluid retention in your legs, ankles, and feet.
• Notify your doctor of any increased pain in joints and muscles and of any numbness or tingling in your hands or feet.
• Exercise to keep your joints flexible and your muscles strong.

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