Having ankylosing spondylitis (AS) will not directly affect your ability to conceive. However, some medications, including sulfasalazine, can cause a decrease in sperm count and therefore can lead to a temporary decrease in male fertility. This effect reverses when you stop taking the medication. In this article, we will consider pregnancy with ankylosing spondylitis.



Pregnancy with ankylosing spondylitis

Having ankylosing spondylitis does not adversely affect your pregnancy or the well-being of your unborn baby. The incidence of miscarriage, stillbirth and a low number of newborns of gestational age among women with AS is similar to that of other healthy women.

  • Women with AS usually have healthy children and they carry them out for the full term.
  • Women with AS are no more likely than other healthy women to have preeclampsia or premature birth.

Symptoms during pregnancy.

During pregnancy, women have no symptoms. Some find that their symptoms are getting better. Some believe that they remain more or less the same, while others believe that they are getting worse.

Exercise during pregnancy

It is important for you to continue exercising for as long as possible during pregnancy. It will help with both your overall health and your ankylosing spondylitis. As your pregnancy progresses and you gain weight, it may be easier for you to exercise in the pool, where water will help support your weight.

Medicines and Pregnancy

Ideally, you are not taking any medication while pregnant or breastfeeding. The reality is that you may have active AS at some point in your pregnancy and need pain relief. It will be important to discuss this with your rheumatology team, ideally in advance, so you know what options are available to you. This will avoid situations where your AU flares up and you are unsure of what medications you can use and cannot use safely.

Anti-inflammatory drugs.

Recommendations for anti-inflammatory drugs in pregnancy are categorized as NSAIDs and coxibs or COX-2 specific NSAIDs (including celecoxib and etoricoxib).  

NSAIDs.

Should be used with caution during the first trimester, as some studies on a large scale have shown a slightly increased risk of miscarriage. Can be taken during the second and third trimester, but should be stopped for a week. Can be taken while breastfeeding.

Coxibs.

There are insufficient data on the use of coxibs or COX-2-specific NSAIDs and should therefore be avoided during conception and pregnancy.

Steroids.

If you have pain in one or two specific joints, you may find a local steroid injection into the joint helpful. Single steroid injections should not interfere with pregnancy. However, make sure your doctor knows you are pregnant before giving a topical steroid injection.

Oral steroids can be used during all stages of pregnancy and breastfeeding. If you are taking oral steroids (prednisone) and are planning a family or are pregnant, discuss this with your doctor or rheumatologist.


Basic antirheumatic drugs

Methotrexate should not be taken during conception or pregnancy. Both men and women who use these drugs must take contraceptive measures. After stopping methotrexate, men and women must continue to use contraception for at least 3 months before trying to get pregnant.

Sulfasalazine is considered safe during pregnancy, however, like all other medicines, it can be stopped during pregnancy. It will be important to discuss your personal situation with your rheumatologist before getting pregnant. This advice applies to both men and women.   .

Anti-TNF therapy for ankylosing spondylitis

Anti-TNF should not be used regularly during pregnancy. If you are using therapy, it is very important that you discuss your options with your rheumatology team before getting pregnant. You may well decide that you do not need or need to take anti-TNF during pregnancy. The current advice is that if anti-TNF is needed during pregnancy:

  • adalimumab and etanercept should be avoided during the third trimester. This is due to a theoretical increase in the risk of neonatal infection.
  • infliximab should be discontinued after 16 weeks. This is again associated with a theoretical increased risk of neonatal infection.

If these drugs are continued later in pregnancy to treat active disease, then live vaccines should be avoided in infants less than seven months of age.

Based on limited data, certolizumab is compatible with all three trimesters of pregnancy in ankylosing spondylitis and reduced placental transfer compared to other TNFs.

Childbirth

Sacroiliac joint or hip problems, even including a complete hip replacement, do not necessarily have to prevent you from having a natural birth. There are various positions that you can use and they will become more comfortable for you. Talk to your midwife about different positions. 

It is a good idea to make an appointment to speak with your midwife (or ideally an anesthesiologist) ahead of time about pain relief during your labor. Many women opt for epidural treatment during labor. This can sometimes be technically more difficult to manage. Your midwife or anesthesiologist will be able to tell you about other options available.




We know that cesarean sections are more common in women with ankylosing spondylitis. This is sometimes because obstetricians prefer to have an elective cesarean section for women with inflammatory joint disease.

 This information is not intended as a substitute for medical advice from a qualified professional. Do not stop taking any medication you have been prescribed for ankylosing spondylitis without talking to your doctor. Pregnancy with ankylosing spondylitis, see above.



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