What to Know About Axial Spondyloarthritis and Pregnancy

Research on axial spondyloarthritis (axSpA) and pregnancy are mixed. This type of arthritis develops at any age but most commonly begins between the ages of 20 and 40, which is also when some people start thinking about becoming pregnant.

The disease may worsen, improve, or stay the same during pregnancy. However, research shows that people with axSpA can have a healthy pregnancy and baby.

This article provides an overview of how axial spondyloarthritis affects your fertility, pregnancy, and the postpartum period. 

Axial Spondyloarthritis and Fertility

Axial spondyloarthritis does not appear to affect a person’s fertility or ability to become pregnant. 

Since a person with axSpA may experience worsening symptoms during pregnancy, it’s important to plan. Talk with your healthcare provider if you’re planning to become pregnant. If your disease symptoms, such as pain, are not under control, consider waiting to become pregnant until your treatment has been adjusted. 

Some treatment options for axSpA are not approved during pregnancy, so planning with your healthcare provider is crucial. 

Axial Spondyloarthritis and Gestation

While axSpA does not affect your ability to become pregnant, it may significantly affect your pregnancy and growing baby. This is especially true in the second trimester. Fortunately, it is possible to have a healthy pregnancy and baby when you have this type of arthritis.

Risks

People with axSpA are at increased risk of certain pregnancy complications, including:

• Preeclampsia: People with axSpA experience a higher rate of preeclampsia (high blood pressure during pregnancy) than those without the disease.
• Cesarean section (C-section): C-sections are almost twice as high in people with axSpA than those without the disease. This may be due to the increased risk of preeclampsia. 
• Preterm birth: The increased risk of preterm birth may also be related to preeclampsia.

Babies born to people with axSpA may also be at a slightly increased risk of:

• Low birth weight
• Congenital abnormalities
• Neonatal intensive care unit (NICU) admission 

People with axSpA are not at an increased risk of stillbirth, gestational diabetes, or miscarriage. 

Treatment

AxSpA treatment may need to be adjusted when you become pregnant. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) are a common arthritis treatment but are only considered safe until 20 weeks of pregnancy. If taken longer, they may lead to kidney damage in the baby.

Medications used to treat axSpA include:

• NSAIDs like Advil (ibuprofen) or Aleve (naproxen)
• Analgesics like Tylenol (acetaminophen)
• Disease-modifying antirheumatic drugs (DMARDs)
• Biologics
• Corticosteroids like prednisone 

NSAIDs and Tylenol are usually safe for part of your pregnancy. The Food and Drug Administration (FDA) approved the biologic medication Cimzia (certolizumab pegol) for use in pregnant people. Research shows that it has a “negligible to low transfer” through the placenta or breast milk, meaning it likely does not affect the baby.

Other axSpA treatments that can be continued throughout pregnancy include:

• Gentle exercise
• Physical therapy
• Assistive devices
• Healthy diet
• Avoiding smoking
• Regular stretching
• Pacing yourself 

Concerning Symptoms

Your disease symptoms can worsen during pregnancy, especially during the second trimester. Talk with your healthcare provider if you develop pain and swelling that interferes with your ability to function. People with axSpA most commonly experience low back and hip pain. 

If you develop any symptoms of preeclampsia, let your healthcare provider know immediately. Possible symptoms include:

• Sudden swelling in your hands or feet
• Rapid weight gain 
• Severe headache 
• Vision changes
• Feeling light-headed or dizzy 
  

Axial Spondyloarthritis and Postpartum

You may need extra support during your postpartum period, even if you had a healthy childbirth experience and baby. This is an important time to take care of your body and promote healing by resting as often as possible, eating a nutritious diet, and taking your prescribed medications. 

Impact on Recovery

If you had back or hip pain during your pregnancy, you may experience worsening pain after childbirth. It is not uncommon to experience a disease flare in the weeks or months after delivery. 

Breastfeeding

AxSpA does not affect your body’s ability to produce breast milk. If you choose to breastfeed your baby, there are a few factors to remember.

Find a comfortable position for feeding times. You may be experiencing increased pain, so talk with a lactation consultant about the best positions for your body and health. 

Talk with your healthcare provider about your current medications and make adjustments. If a medicine can be passed through the breast milk, you may need to find an alternative treatment while breastfeeding.

Summary

Axial spondyloarthritis can cause pain and swelling throughout the spine. This type of arthritis does not affect your ability to become pregnant. People with axSpA may be at an increased risk of preeclampsia, C-section, and preterm birth. After labor and delivery, it is possible to experience an increase in pain and symptoms. Work closely with your healthcare provider to manage your symptoms while recovering from childbirth.