Zanzu (zanzu.no)
Information about pregnancy and birth for immigrants and others who have not been in Norway for long. Available in Arabic, English, Farsi, French, Norwegian, Polish, Somali, Tigrinya and Turkish.
It is best to plan your pregnancy to a time when you have low disease activity. Your doctor should always do an individual evaluation of how a pregnancy can affect you and what your risk factors are, based on your diagnosis and the seriousness of your symptoms.
Many with rheumatic disease have questions regarding heredity, and the possibility that they will pass on their disease if they have children. There is little reason to worry about this. The general risk that your children will develop a rheumatic disease is low, and we do not say that rheumatic diseases are heritable in the common definition of the term. There are some families where many have rheumatic diseases, but this is rare.
Recommended follow-up before, during and after pregnancy for women with inflammatory rheumatic disease
Women with inflammatory rheumatic diseases are recommended extra follow up during and after pregnancy.
The level of risk in relation to pregnancy for women with rheumatic diseases varies significantly between diagnoses. Women with inflammatory arthritis (joint disease) generally have lower risk for complications, compared to women with systemic diseases (connective tissue disease and vasculitis). Recommended follow up therefore differ between these patient-groups. It is however important to remember that there are individual variations, and women with the same diagnosis can have different risk-profiles and therefore different follow-up.
The following recommendations are based on the national guideline from The Norwegian Society for Gynecology and Obstetrics, and the guideline from the Norwegian National Advisory Unit on Pregnancy and Rheumatic diseases. The number of consultations as described here are the minimum number of recommended controls.
Everyone, regardless of diagnosis, should also have standard antenatal care from the primary care provider (general practitioner and/or midwife). The consultations at the hospital in relation to your rheumatic disease are on top off, not instead of, these consultations.
Recommended timepoints for follow up - low-risk (inflammatory arthritis/joint disease)
| Rheumatology department | Obstetric control |
| Pre-pregnancy consultation | |
| 1. trimester | Approx. week 12: Ultrasound and general risk assessment |
| 2. trimester | Approx. week 18: Ultrasound |
| 3. trimester | Approx. week 32: Ultrasound (fetal growth scan), and consulting obstetrician regarding birth plan |
| Approx. 6 weeks, 6 months and 12 months after giving birth |
Recommended time points for follow up – high risk (connective tissue disorders/vasculitis)
| Rheumatology department | Obstetric control |
| Pre-pregnancy consultation | Approx. week 12: Ultrasound and general risk assessment |
| 2. trimester | Approx. week 18: Ultrasound |
| Approx. week 24: Ultrasound (fetal growth scan) | |
| Approx. week 28: Ultrasound (fetal growth scan) | |
| 3. trimester | Approx. week 32: Ultrasound (fetal growth scan), and consulting obstetrician regarding birth plan |
|
Approx. week 36: Ultrasound (fetal growth scan) |
|
| Approx. 6 weeks, 6 months and 12 months after giving birth |
Prepare for your consultations:
To ensure you get the most out of your health care appointments before, during and after your pregnancy, we recommend that you are prepared for the consultations.
We have developed a checklist, to help you remember relevant topics that should be discussed with your rheumatologist or others from your rheumatology health care team.
Checklist – what you could discuss with your rheumatologist or other health care provider regarding pregnancy
- Relevant medical treatment (before, during and after pregnancy)
- Will my pregnancy affect my disease?
- Will my disease affect my pregnancy?
- What can I do to optimize my health (exercise and lifestyle)?
- Where can I find updated and relevant information?
- How should my follow-up be?
- Should I have follow up from a multidisciplinary team (physiotherapist, occupational therapist, social worker)?
- Labour
- Breastfeeding
- Social network
- Practical solutions in everyday life
Medications before, during and after pregnancy
The risk and possible negative consequences of using medications should always be discussed with you doctor when planning a pregnancy. The benefits of using medications need to be weighed against the possible negative consequences. Some medications need to be discontinued a long time prior to conception, while others can and should be used during the entire pregnancy. Men with rheumatic disease should also discuss their medications with health professionals if they are planning on making their partner pregnant.
It is important to remember that advice regarding the use of medications is based on individual risk factors and needs, and people with the same diagnosis might therefore receive different advice regarding what medications they should and should not use.
Rheumatoid Arthritis and pregnancy
Pregnancy can affect women with rheumatoid arthritis in different ways. About 60 percent of women with rheumatoid arthritis experience improvement of symptoms during pregnancy. It is not known why some experience this improvement while others do not.
About 60 percent of patients with rheumatoid arthritis experience a flare after delivery. This usually occurs up to six months after delivery, and may require medical treatment. The disease activity will normally stabilize, and return to the pre pregnancy state within the first year after delivery. Women with rheumatoid arthritis can breastfeed as long as their medications are compatible with breastfeeding.
Psoriatic arthritis and pregnancy
Some women with psoriatic arthritis experience improvement of their disease activity in pregnancy while others do not. It is not known why some experience improvement while others do not. Skin rash usually remains stable or improves.
Many experience a flare within 6 months after delivery and may require medical treatment. The disease activity will normally stabilize, and return to the pre pregnancy state within the first year after delivery. Patients with psoriatic arthritis can breastfeed as long as their medications are compatible with breastfeeding.
Juvenile Idiopathic Arthritis and pregnancy
Approximately 50 percent of women with juvenile idiopathic arthritis have inactive disease in adulthood. If you were diagnosed with JIA in early childhood, you should consult your rheumatologist when planning a pregnancy. The rheumatologist will decide if it is necessary with any pre examinations, such as x-ray.
Around 50 percent of women with juvenile idiopathic arthritis experience a flare of their disease within 6 months after delivery and may require medical treatment. Women who have had inactive disease in adulthood can also experience this flare. The flare is usually temporary, and the disease activity typically stabilizes within the first year after delivery. Women with juvenile idiopathic arthritis can breastfeed as long as their medications are compatible with breastfeeding.
Axial Spondyloarthritis and pregnancy
Some women with axial spondyloarthritis (axSpA) experience a flare of disease activity in pregnancy while others do not experience significant change in disease activity. The back- and joint pain may feel more intense when normal pregnancy symptoms appear.
It is important for women with axSpA to stay physically active during their pregnancy. You might benefit from physiotherapy or a training program that is tailored for your specific needs during pregnancy.
Vaginal delivery is generally recommended for women with SpA as long as your disease has not lead to significantly reduced mobility in your back, hips or pelvis. Method of delivery is decided by the obstetrician together with the patient. Many women with SpA experience a worsening of symptoms up to 6 months after delivery. This increase in disease activity is usually temporary, and the disease activity usually stabilizes within a year after delivery.
Women with axSpA can breastfeed as long as their medications are compatible with breastfeeding.
Pregnancy in women with lupus and other connective tissue disorders
Today we know that pregnancy in women with lupus is far from as high risk as previously believed. It is however vital that you plan your pregnancy if you have lupus or other connective tissue disorders. This significantly increases the likelihood of a positive outcome for both mother and baby.
Many women with lupus experience normal pregnancies, but there may be complications during pregnancy, and it is important to be aware of this. The disease should be in remission and stable for at least six months before trying to get pregnant. Since active lupus nephritis is a risk factor for both mother and foetus, it is very important that this is stable and inactive.
Women with active lupus should consult appropriate specialists – such as rheumatologists, gynaecologists, nephrologists, cardiologist, and haematologist, when planning a pregnancy. Patients with SLE and other connective diseases should also have close follow up during pregnancy by specialists with monthly controls in their first and second trimester. More frequent controls are recommended in the last trimester and also if there are signs of disease flares.
It is recommended that women with lupus use the medication Plaquenil during pregnancy to prevent flares, unless there are any contraindications. The use of Plaquenil is harmless for the baby.
Disease activity in women with lupus may vary in pregnancy in the same way as before pregnancy. Around 50 percent of pregnant women with lupus experience acute flare that needs treatment during pregnancy. Symptoms may be swollen or tender joints, skin rash or fatigue. It is important to remember that women with lupus also experience normal pregnancy symptoms that are not related to their lupus. Normal changes related to pregnancy can be fluid retention, swollen joints, rash and hair loss.
20 percent of women with lupus may experience protein in their urine during pregnancy. This can be a sign of nephritis. Increased blood pressure combined with protein in urine can also be a sign of preeclampsia. Some women with lupus have a type of antibodies called antiphospholipid antibodies in their blood which increases their risk of spontaneous abortion and thrombosis. If you have these antibodies and have previously experienced spontaneous abortions or thrombosis, you will need preventative treatment with blood thinners.
It is important that women with SLE also have follow up controls in the year after delivery, as there is a higher risk of flare in the first year after giving birth.