What to Know About Axial Spondyloarthritis and Pregnancy

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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. 

Young woman holding her pregnant belly

AleksandarNakic / Getty Images

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. 

Is AS Hereditary?

The exact cause of axial spondyloarthritis is unknown, but we know there is a genetic component since axSpA is an autoimmune disease. Research shows that most people with the condition (about 90%) are positive for HLA-B27. However, many people with this gene never develop axSpA. 

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.


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:

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


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 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. 


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.


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. 

Frequently Asked Questions

  • Can people with axial spondyloarthritis get pregnant?

    Yes, a diagnosis of axial spondyloarthritis does not affect your fertility or ability to become pregnant. It may affect your pregnancy, so talk with your healthcare provider about becoming pregnant.

  • Can I take biological medication when pregnant?

    If you have axial spondyloarthritis and recently discovered you are pregnant, talk with your healthcare provider about adjusting your treatment plan. Some medications are not safe to take during your pregnancy. The biological medication Cimzia (certolizumab pegol) has been approved during pregnancy, but others have not.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Spondylitis Association of America. Disease activity during and after pregnancy in women with axial spondyloarthritis.

  3. Arthritis Foundation. Ankylosing spondylitis and pregnancy.

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  5. Zbinden A, van den Brandt S, Østensen M, Villiger PM, Förger F. Risk for adverse pregnancy outcome in axial spondyloarthritis and rheumatoid arthritis: disease activity matters. Rheumatology (Oxford). 2018;57(7):1235-1242. doi:10.1093/rheumatology/key053

  6. Maguire S, O’Dwyer T, Mockler D, O’Shea F, Wilson F. Pregnancy in axial spondyloarthropathy: A systematic review & meta-analysisSeminars in Arthritis and Rheumatism. 2020;50(6):1269-1279.doi:10.1016/j.semarthrit.2020.08.011

  7. Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Disease activity during and after pregnancy in women with axial spondyloarthritis: a prospective multicentre study. Rheumatology (Oxford). 2018;57(6):1064-1071. doi:10.1093/rheumatology/key047

  8. MedlinePlus. Preeclampsia.

By Carrie Madormo, RN, MPH
Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.