There is considerable variation in the severity and degree of risk associated with the different diagnoses. Patients with assumed lower risk and patients with assumed higher risk will consequently receive different specialist pregnancy care.
There are large individual variations. Two women with the same diagnosis may also have very different risk profiles, and therefore also receive differentiated– specialist care.
Common to all women with rheumatic disease, regardless of their diagnosis, is that they should receive routine pregnancy care within the primary health service from a GP and/or midwife in the same way as other healthy pregnant women. The check-ups you have within the specialist health service will always be supplemental to, rather than replacing, the routine maternity care.
Specialist maternity care for low-risk pregnancy
Women with arthritic diseases usually have a low risk of complications in pregnancy. However, they are recommended to attend check-ups for their rheumatic disease when pregnant. You will be offered check-ups when planning a pregnancy, during pregnancy and in the first 12 months after childbirth.
In addition, you should attend check-ups at a hospital gynaecology/obstetrics department:
Recommended check-ups at the rheumatology department |
Recommended check-ups at the gynaecology/obstetrics department |
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Pre-pregnancy planning |
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1st trimester |
Approx. week 12 Routine ultrasound |
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2nd trimester |
Approx. week 18 Routine ultrasound |
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3rd trimester |
Approx. week 32 Ultrasound – Foetal Growth Scan |
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Approx. 6 weeks, 6 months and 12 months after childbirth |
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Maternity care for women at higher risk
Women with systemic diseases (connective tissue disorder and any disorder involving vasculitis) are at higher risk, and will therefore also be offered more frequent and more specialised maternity care appointments. You will be offered check-ups for your rheumatic disease in connection with pregnancy. You will be offered check-ups when planning a pregnancy, during pregnancy and in the first 12 months after childbirth. The frequency of your check-ups will be individual and decided by your specialist.
In addition, you will have check-ups at the gynaecology/obstetrics department:
Recommended check-ups at the rheumatology department |
Recommended check-ups at the gynaecology/obstetrics department |
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Pre-pregnancy planning |
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1st trimester |
Approx. week 12 Routine ultrasound, and general risk assessment, planning of follow-up and information about childbirth. |
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2nd trimester |
Approx. week 18 – Routine ultrasound Approx. week 24 – Ultrasound – Foetal Growth Control Approx. week 28 – Ultrasound – Foetal Growth Control |
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3rd trimester |
Approx. week 32 – Ultrasound – Foetal Growth Control Approx. week 36 – Ultrasound – Foetal Growth Control |
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Approx. 6 weeks, 6 months and 12 months after childbirth |
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Preparing for your appointments
To ensure that you receive the best possible maternity care, and that you get the most benefit from your appointments with healthcare professionals, you should come well prepared.
Click this link for a useful checklist from The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR) (in Norwegian) to help you remember relevant topics to discuss concerning pregnancy and rheumatic disease.
Does rheumatic disease affect childbirth?
Just like healthy women, pregnant women with a rheumatic disease have many questions and concerns about childbirth. Most rheumatic diseases do not increase the risk of complications during childbirth, and as a rule, normal childbirth is recommended.
It is rare that the disease itself prevents normal childbirth. If all goes well during your pregnancy, you can carry your baby to term and give birth normally.
Read more about different birth locations, home births and induction of labour.
The time after childbirth
After having a baby, many women with a rheumatic disease experience worsening of the disease (flare). This may happen regardless of when your menstrual periods start again and whether you are breastfeeding.
With a new baby to look after, the symptoms may seem more of a strain than they were before. For the vast majority of women, the flare is transient (not lasting), and the disease will eventually resolve to the same level as before pregnancy.
Medicinal treatment
To prevent disease flare in the postnatal period, it is usually advisable to start anti-rheumatic treatment immediately after giving birth. It is important to discuss the medicines you can take while breastfeeding with your rheumatologist. If you wait too long after having your baby to start taking your medicines, it may be difficult to keep the disease activity under control.
Physiotherapy and occupational therapy
The first few months after having a baby may pose challenges in terms of the physical care of your baby and the new strain on your body of lifting and carrying. You may also find it difficult to prioritise physical activity and exercise initially. An occupational therapist and physiotherapist can support you by providing practical advice.
Practical advice for parents with rheumatic disease
This article offers advice on practical adaptations, what you should be aware of when buying baby equipment, and on assistive products you can use.