What to Know About Fibromyalgia and Pregnancy

Fibromyalgia is a chronic condition that causes widespread pain, fatigue, cognitive dysfunction, and dozens of potential body-wide symptoms. It’s a multisystem illness involving the brain and nerves, immune system, and hormones.

If you have fibromyalgia and are contemplating pregnancy, it’s natural to wonder what impact your illness will have on your ability to get pregnant, the pregnancy itself, delivery and recovery, the health of your baby, and the short- and long-term severity of your fibromyalgia.

Research is starting to provide a more complete picture of pregnancy with fibromyalgia, and much of the news is encouraging. While you may face some additional risks and challenges because of your condition and its treatments, the most common outcome is a successful pregnancy, a healthy baby, and no long-term worsening of fibromyalgia symptoms.

Fibromyalgia and Fertility

While research is far from exhaustive, from the work that’s been done so far, it doesn’t appear that fibromyalgia impairs your fertility. However, you may have common overlapping conditions that make it more difficult to get pregnant.

These conditions include:

• Endometriosis, in which the tissue that normally lines the inside of your uterus grows outside the uterus
• Autoimmune diseases, such as lupus or rheumatoid arthritis
• Premature ovarian insufficiency, which occurs when the ovaries fail to work normally before age 40
• Thyroid disease
• Premature menopause
• Obesity
• Irregular menstrual periods

If you have one or more of these conditions, talk to your doctor about how it may affect your fertility and what may help increase your chances of getting pregnant. 

Fibromyalgia and Gestation

While a small percentage of people report that their fibromyalgia symptoms eased during pregnancy, most of the time symptoms become more severe. The symptoms reported in studies to be most bothersome include:

• Pain, especially in the low back, chest, abdomen, and legs
• Headaches
• Dizziness
• Physical disability
• Fatigue and unrefreshing sleep
• Muscle weakness
• Cognitive dysfunction
• Constipation
• Nausea
• Frequent urination
• Anxiety
• Depression
• Fear of childbirth

Anxiety, depression, and fear of childbirth were worse in those with more severe fibromyalgia symptoms. All symptoms tended to increase in the third trimester, which is when most pregnancy-related symptoms are at their worst.

For those who feel some relief from fibromyalgia symptoms during pregnancy, doctors speculate that it’s due to increased levels of the hormone relaxin, which loosens up the ligaments in the pelvis to prepare the body for delivery. Some doctors suggest relaxin supplements for their pregnant fibromyalgia patients.

Risks

Fibromyalgia may heighten some pregnancy-associated risks for you and your baby, some directly and others indirectly through overlapping conditions. Pregnancy with fibromyalgia is generally considered high risk. 

Overlapping conditions that may increase risks for your pregnancy include:

• Anxiety
• Depression
• Psychological stress

These issues tend to be more common in people with fibromyalgia, and research has shown that they can have an impact on the placenta and fetal development. If you’re experiencing any of these issues, talk to your medical team. They may be able to help you manage them successfully and reduce risks.

Fibromyalgia can also pose risks to your baby, including:

• Intrauterine growth restriction, in which the baby doesn't grow to a normal weight during pregnancy
• Recurrent miscarriage, which is two or more failed pregnancies
• Possible premature delivery, but studies are mixed on this

The condition has not been associated with an elevated risk of any birth defects. 

Research varies on whether fibromyalgia is associated with a higher risk of cesarean deliveries (C-sections). Some researchers say spinal anesthesia, such as that used for C-sections, may exacerbate fibromyalgia symptoms. Talk to your doctor about alternatives to general anesthesia if you should need to have a surgical delivery.

Gestational Diabetes

Gestational diabetes appears to be more common among people with fibromyalgia. It develops during pregnancy and generally goes away immediately after delivery. 

Like type 2 diabetes, the gestational form causes insulin resistance, meaning the body doesn’t use insulin properly to keep blood sugar levels regulated. If left untreated, gestational diabetes can greatly increase the risk of:

• Giving birth to an extra-large baby
• Having preeclampsia, which is high blood pressure during pregnancy that can lead to seizures, stroke, blood clots, brain damage, and premature delivery
• Hypoglycemia (low blood sugar) in the baby soon after birth

Gestational diabetes generally doesn’t cause symptoms, so doctors screen for it automatically between the 24th and 28th weeks of gestation. If you’re diagnosed with the condition, you’ll likely be put on a special diet and you will need to monitor your blood sugar closely. If diet alone doesn’t get your blood sugar into the desirable range, you may be put on insulin.

Early Water Breaking

Fibromyalgia may increase your risk of your water breaking before your baby is full term (37 weeks). This is called preterm premature rupture of the membranes (PPROM). 

Once the fetal membranes have ruptured, you’re at a significantly increased risk of infection, which could put you and your baby in danger. If you’re more than 34 weeks along, your doctor may recommend inducing labor. However, your doctor may also suggest a wait-and-see approach. The options will be clearly discussed with you, including the risks and benefits of each approach for both parent and baby.

However, before 34 weeks, the situation is more complicated because the baby’s lungs likely aren’t developed enough for the baby to be delivered. Treatment generally consists of:

• Bedrest to prevent premature labor
• Antibiotics to prevent infections
• Steroid medications to speed up the baby’s lung development

Once your baby’s lungs are developed enough, your doctor will induce labor.

Placental Abruption

Also possibly tied to fibromyalgia, a placental abruption is separation of the placenta from the wall of the uterus, which allows blood to escape.

This can impair the placenta, meaning your baby may not get enough oxygen and nutrients to develop properly. Severe abruptions can endanger both the baby and the mother due to blood loss.

Symptoms of a placental abruption include:

• Vaginal bleeding
• Uterine and abdominal pain
• Rapid contractions
• Abnormal heart rate in the baby

Treatments for placental abruption depend on whether it’s a partial or complete separation and what stage your pregnancy is in. It may include:

• Bedrest
• Monitoring
• Early delivery
• Emergency delivery, if you’re losing a lot of blood and your life or the baby's life are in jeopardy

Abruptions are most common in the third trimester but are possible as early as 20 weeks' gestation. Always let your obstetrician know about vaginal bleeding during pregnancy, especially in the third trimester.

Venous Thromboembolism 

A potentially deadly complication linked to fibromyalgia pregnancies is venous thromboembolism (VTE). VTE involves a blood clot, usually from a deep vein in the lower body, that breaks loose and travels to the lungs. 

If it’s not treated, a VTE can block blood flow, which can cause organ damage or even death. Symptoms of a blood clot in the legs include:

• Swelling
• Redness
• Pain

If you experience any of these symptoms without an obvious explanation, especially in the legs, contact your doctor right away.

Symptoms of venous thromboembolism if the blood clot has traveled from the legs to the lungs include:

• Sudden chest pain
• Shortness of breath

Venous thromboembolism is treated with medications that prevent additional blood clots or dissolve the clot causing the blockage.

Polyhydramnios (Excess Amniotic Fluid)

In polyhydramnios, too much amniotic fluid builds up around the baby in the amniotic sac. Fibromyalgia may increase your risk of this rare condition. The excess fluid can put extra strain on the uterus that can result in numerous complications, including:

• Premature labor and delivery
• Placental abruption
• Hemorrhage after giving birth
• Umbilical cord prolapse (the cord slips through the cervix before the baby does during labor)
• Abnormal positioning in the womb
• Stillbirth (the loss of the baby before or during labor)

Most often, polyhydramnios is discovered by a doctor when taking measurements of your abdomen since mild cases may not cause symptoms. If it’s more severe, you may experience:

• Tightness in the abdomen
• Indigestion
• Constipation
• Low urine production
• Enlarged vulva (external female genital organs)
• Problems breathing
• Swelling in your hip, leg, or foot

A mild case of polyhydramnios may not need to be treated, but your doctor may monitor you more closely than usual. If the condition is severe or becomes worse, treatment can include:

• Draining amniotic fluid via a large needle
• Being on bedrest
• Inducing early labor

Fibromyalgia Drugs and Your Baby

Medications prescribed for fibromyalgia may not be safe for your baby during pregnancy and breastfeeding. Not much is known about the pregnancy-associated risks of the drugs approved for fibromyalgia by the Food and Drug Administration, but some research has begun to come in, including the following:

• Lyrica (pregabalin): A possible link to structural birth defects
• Cymbalta (duloxetine): An increased risk of complications during pregnancy and delivery
• Savella (milnacipran): Research hasn’t yet looked at the pregnancy-related effects of this drug

Other medications that are commonly prescribed for fibromyalgia may be related to some risks as well, including:

• Antidepressants
• Pain medications

Be sure to talk to your doctor about what medications are best for you during pregnancy and breastfeeding.

Fibromyalgia and Postpartum

Having a new baby is exciting, but it is also a big adjustment for anyone, especially while your body recovers from pregnancy and childbirth. Fibromyalgia may make this period of time harder.

Impact on Recovery

Some doctors say it takes longer to recover from pregnancy when you have fibromyalgia, and that the second pregnancy may be harder to get over than the first. However, more research needs to be performed to be sure.

The good news is that pregnancy doesn't appear to have a long-term impact on fibromyalgia severity.

What’s better understood is that disrupted sleep makes fibromyalgia symptoms worse, and having a new baby almost always leads to sleep disruption. If possible, you may want to arrange for extra help for the first few months of your child’s life so you can get the rest you need.

Help is especially important if you’ve had a C-section since you need to heal from the surgery and can face substantial physical limitations for a while. Gynecological surgery has been tied to the onset of fibromyalgia, and it’s not a stretch to imagine it could make your recovery more difficult.

If you have a history of depression, and especially if you were depressed during pregnancy, you should be closely monitored for postpartum depression.

Breastfeeding

You can breastfeed your baby when you have fibromyalgia, and research has shown that the condition doesn’t appear to shorten the length of time you can successfully breastfeed for.

It’s important, though, to consider a few key points. First is medication. If you went off of successful drug treatments because of your pregnancy, you may want to go back on them as soon as possible after delivery. You may have to make a choice between breastfeeding and resuming treatment.

Second, breastfeeding requires more energy. In fact, you should eat 200 more calories a day while nursing than during pregnancy. It’s important to think about whether your body can handle that increased demand since fibromyalgia already saps your energy.

Frequently Asked Questions

What pain medicine is used for pregnant women with fibromyalgia?

The drug that is most often recommended during pregnancy is Tylenol (acetaminophen) for the first and second trimesters. Opioid painkillers such as Vicodin (hydrocodone-acetaminophen) or OxyContin (oxycodone) are not safe for the baby.

Does fibromyalgia go away when you’re pregnant?

No, fibromyalgia doesn’t go away while you’re pregnant. Some people do find that their symptoms are much less severe during pregnancy, but others may experience more severe symptoms when they’re expecting.

How hard is it to get pregnant with fibromyalgia?

There’s no evidence that fibromyalgia makes it harder to get pregnant. However, a factor may be that pain and fatigue limit sexual activity, which can make it harder to conceive.

Overlapping thyroid diseaseand conditions that make ovulation or menstruation irregular may complicate getting pregnant as well.

How do you deal with bad fibromyalgia pain while pregnant?

Because medication use is best limited during pregnancy, you may want to explore complementary and alternative fibromyalgia treatments, including:

• Yoga or gentle stretching
• Mindfulness meditation
• Acupuncture
• Cupping
• Gentle massage
• Myofascial release

Before using heating pads or hot baths to help with pain, talk to your doctor about how to use heat safely while you’re pregnant. Also ask about topical pain relievers since they are absorbed into your bloodstream.

Summary

Fibromyalgia by itself doesn't make it harder to get pregnant, but some comorbid conditions might. If you do get pregnant, you have to reevaluate your fibromyalgia medications with your doctor to make sure they won't hurt your baby. As long as you work closely with your medical team throughout and after your pregnancy, it's possible to stay healthy yourself and have a healthy baby.

A Word From Verywell

Pregnancy always comes with some risks, and contemplating the extra risks and complications of fibromyalgia can be daunting. However, remember that fibromyalgia doesn’t have to keep you from getting pregnant and having a healthy baby. Work closely with your doctors so they can help you get through this difficult but also rewarding time.