Maternity care and childbirth for women with inflammatory rheumatic disease

Women with inflammatory rheumatic disease should receive specialist medical care before, during and after a pregnancy. This is in addition to the routine maternity care provided by a GP and/or midwife within the primary health service. In most cases, normal childbirth is recommended.

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

Pre-pregnancy planning

 

1st trimester

Approx. week 12 Routine ultrasound

2nd trimester

Approx. week 18 Routine ultrasound

3rd trimester

Approx. week 32 Ultrasound – Foetal Growth Scan
+ antenatal counselling as needed

Approx. 6 weeks, 6 months and 12 months after childbirth

 

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

Pre-pregnancy planning

 

1st trimester

Approx. week 12 Routine ultrasound, and general risk assessment, planning of follow-up and information about childbirth.

2nd trimester

Approx. week 18 – Routine ultrasound

Approx. week 24 – Ultrasound – Foetal Growth Control

Approx. week 28 – Ultrasound – Foetal Growth Control

3rd trimester

Approx. week 32 – Ultrasound – Foetal Growth Control
+ antenatal counselling

Approx. week 36 – Ultrasound – Foetal Growth Control

Approx. 6 weeks, 6 months and 12 months after childbirth

 

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.  

The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR)

Monday-Friday from 08:00 to 15:00

Advises both patients and health professionals.

Norsk revmatikerforbund (Norwegian Rheumatism Association)

22 54 76 00

Tuesday from 10:00 to 15:00

Wednesday from 10:00 to 15:00

Thursday from 10:00 to 15:00

Calls are answered by people with a rheumatic disease, who can give you advice and guidance.

Podcast: Revmamas

A podcast (in Norwegian) for women who have a rheumatic disease and are planning a pregnancy or are pregnant. 

You’ll find it where you usually listen to podcasts, like Spotify for example.

Trygg mammamedisin

Get advice from professionals about safe medication use during pregnancy and breastfeeding. The service is free of charge.

Nasjonal kompetansetjeneste for svangerskap og revmatiske sykdommer. Veileder i svangerskap og revmatiske sykdommer.[Internett].Trondheim: St. Olavs hospital [hentet 2021-01-04]. Tilgjengelig fra: https://www.nksr.no/oppfolging/

Content provided by The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR)

The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR). Maternity care and childbirth for women with inflammatory rheumatic disease. [Internet]. Oslo: The Norwegian Directorate of Health; updated Tuesday, October 10, 2023 [retrieved Friday, March 1, 2024]. Available from: https://www.helsenorge.no/en/pregnancy-and-maternity-care-in-norway/pregnancy-childbirth-family-life-rheumatic-disease/maternity-care-and-childbirth-for-women-with-inflammatory-rheumatic-disease/

Last updated Tuesday, October 10, 2023