Pregnancy and Ankylosing Spondylitis

Should you be concerned about having a baby if you have ankylosing spondylitis?

Learning you’re pregnant brings a torrent of emotions, such as excitement, joy, and anticipation. But if you also have ankylosing spondylitis (AS), a form of spinal inflammatory arthritis, it can also raise fear and concern.

  • Does my condition pose risks to my baby?
  • Will my pregnancy worsen my AS?
  • Will my medications need to change?

This article shares what you need to know about pregnancy with AS, including answers to frequently asked questions about ankylosing spondylitis’ effect on fertility and pregnancy. While this information is accurate to the best of our knowledge, it may not be applicable to all women with ankylosing spondylitis who wish to become pregnant or are currently pregnant. We urge you to share these questions with your rheumatologist and obstetrician and rely on him/her for individual medical advice related to your AS and health.
Experienced female physician giving the medicine to a pregnant patient.Your doctor can explain the risks and benefits—both to you and your baby—of continuing or stopping a medication during pregnancy.

Pregnancy and Ankylosing Spondylitis: Q&A

Q: Will having AS hurt my chances of getting pregnant?
A:
Fortunately, AS doesn’t seem to influence a woman’s ability to get pregnant. Women with the condition should expect to get pregnant at the same rate as women who don’t have AS.

Q: How will pregnancy affect my ankylosing spondylitis symptoms?
A:
Studies about AS symptoms during pregnancy show mixed results. Some studies conclude that a woman’s symptoms are not likely to change during pregnancy, but some women report an increase in pain. Interestingly, some women say their symptoms actually improved during pregnancy.

Women whose symptoms are primarily in the hip and spine tend to see their symptoms worsen during pregnancy. On the other hand, women with AS pain farther away from their spine—in their shoulders and knees, for instance—tend to experience symptom improvement during pregnancy.

As you progress in your pregnancy, you may experience low back pain—a symptom many pregnant women share (even those without any pre-existing spinal condition). The baby puts extra pressure on your spine as he or she grows, which can cause pain.

Q: Does AS increase my miscarriage risk?
A:
Ankylosing spondylitis does not appear to increase the risk for miscarriage. There’s also no link connecting AS to stillbirth or premature labor.

Q: Does having AS increase my risk for pregnancy complications?
A:
Studies examining pregnancy complications in women with AS show no long-term adverse effects on either the mother or the baby. Most women with AS have healthy, full-term deliveries. However, your risk for developing complications may increase if your AS is not well controlled and/or if you have other medical conditions.

Q: Can I have a vaginal delivery with AS?
A:
Vaginal delivery is possible for women with AS, even if you have sacroiliac joint and low back pain. During your prenatal visits, talk to your doctor about your desire to have a vaginal birth. He or she will help you understand any risks, and if Cesarean section (C-section) is a better option.

Q: Will I be able to have an epidural during delivery?
A:
Possibly not. If you have severe spinal inflammation or have undergone a spinal fusion, your doctor may have difficulty administering an epidural. Epidurals are powerful anesthetics used to relieve pain in both vaginal and C-section births. If you are having a C-section, you may have to use general anesthesia.

Prior to birth, meet with your anesthesiologist to understand your options. Imaging tests (such as an x-ray) of your low back can help your anesthesiologist see whether an epidural is possible. This extra planning will get everyone on the same page, and will allow you to mentally prepare for your level of pain management during labor and delivery.

Q: What do I need to know about flares after I have the baby?
A:
Disease flares after giving birth are common—a study found that as many as 60% of women with AS had a flare shortly after delivery. You’re more likely to have a postpartum flare if your disease was not well controlled when you became pregnant, so consider taking steps to better manage your AS before becoming pregnant.

Should You Adjust Your AS Medication Regimen While Pregnant?
Understanding which medications are safe during pregnancy is important for all pregnant women. For women with AS, this is among the most important initial conversations you should have with your rheumatologist and obstetrician.

Ideally, talk to your doctor before conceiving, or as soon as you learn you’re pregnant, to learn what needs to change in your medication regimen. Your doctor can explain the risks and benefits—both to you and your baby—of continuing or stopping a medication during pregnancy.

In general, medication therapy for AS almost always includes non-steroidal anti-inflammatory drugs (NSAIDs). This class of medication should be avoided when pregnant, as it may pose a risk to your baby. Instead, you may use acetaminophen (Tylenol) to ease symptoms. Your doctor may also consider steroid injections for pain.

Make Exercise Part of Your Pregnancy
Physical activity is one of the best ways to support a healthy pregnancy—and it’s especially beneficial for women with AS. Exercising with ankylosing spondylitis will stretch ligaments and strengthen muscles, which helps ease joint pain.

Walking, swimming, and prenatal yoga are great exercise options during pregnancy. If your AS is active, your doctor may refer you to a physical therapist to help keep you safely active during your pregnancy.

While exercise is generally encouraged during pregnancy, every woman and pregnancy is different. Exercise while pregnant should be done under your doctor’s supervision. Talk to your doctor about the types of activities you should engage in, and what your activity level throughout pregnancy should look like.

Pregnancy with AS: A Little Planning Goes a Long Way
Ankylosing spondylitis is not a barrier to a happy, healthy pregnancy, but that doesn’t mean it won’t be stress free. One of the best ways to banish your fears is by being prepared. Stay in close contact with key members of your health care team—your obstetrician, rheumatologist, and anesthesiologist. Asking the right questions and being informed will help you move confidently throughout your pregnancy and delivery.

Updated on: 01/05/18
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Symptoms of Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic disease that develops slowly.
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