Pregnancy and Ankylosing Spondylitis
A major concern for women with spondylitis centers around issues of child bearing. What influence will pregnancy have on the course of the disease? Are there fetal risks from the disease or from the medications used during pregnancy? What is the risk of the child developing spondylitis?
Approximately 50% of spondylitis patients have no change in the severity of their disease during pregnancy. 25% will have a lessening of symptoms, particularly those with arthritis affecting the joints of the hands and feet or those with associated inflammatory bowel disease or psoriasis. About 25% of pregnant women will notice a temporary worsening of their symptoms with increased morning stiffness and back pain at rest.
Post-delivery, about one half of women note a flare of disease activity within six months. The vast majority of the women will have full-term normal deliveries. Even those patients with sacroiliac joint and spinal involvement or even hip replacements usually do not require Caesarean sections. The complication rate in the newborn does not differ from that expected in the unaffected population. So, one can conclude that pregnancy has no long-term detrimental effects on the mother or fetus and can be safely undertaken.
AS Treatment Modification During Pregnancy
Treatment of spondylitis must be modified during pregnancy. Non-steroidal anti-inflammatory agents (NSAIDs), a cornerstone of therapy for spondylitis, are best avoided. An active exercise program during pregnancy is essential. You should stretch ligaments, strengthen muscles and maintain lung capacity. Walking, biking and swimming are encouraged. In patients who experience a flare of symptoms, working with a physical therapist can be helpful, especially if access to a warm water pool is available. This can reduce your need for medications.
For patients who are put to bed rest for uterine bleeding or to avoid premature labor, supervised exercise is a must since a lack of exercise can increase the chances of fetal deformities. Acetaminophen (Tylenol) can be used for patients who are experiencing a severe flare of the disease. Your doctor may also prescribe steroid injections, or even low doses of oral steroids. While you should try to avoid using NSAIDs, it should be noted that, although the above cautions apply, there have been many reports of women who have used these drugs during pregnancy without affecting themselves or the child. Naproxen, Ibuprofen and Indomethacin have been reported to be the safest.
NSAIDs are excreted in minute amounts in breast milk, therefore breast feeding should be avoided in patients who require them. Since post-partum flares are frequent, the pregnant patient should plan to enlist help from family and friends.
This article is an excerpt from Straight Talk On Spondylitis, which is published by the Spondylitis Association of America. You can learn more about the SAA and purchase your own copy of Straight Talk by visiting their website, www.spondylitis.org.
For additional reading on spondylitis in women, you can request the Ankylosing Spondylitis: Also A Woman's Disease brochure from the Spondylitis Association of America. This free brochure can be ordered online.