• Having axial spondyloarthritis (axSpA) does not affect your chances of getting pregnant.
• Risk factors for pregnancy complications may depend on disease severity. Your doctor may suggest working with a high-risk pregnancy specialist to help manage potential risks.
• Talk to your health care team well in advance. Your doctors can work with you to develop a safe treatment plan prior to pregnancy, during pregnancy, and postpartum.

Many people with axial spondyloarthritis have questions about pregnancy. Disease activity, fertility, treatment, delivery, breastfeeding, and early motherhood can present risks that need to be assessed and managed carefully in people with axSpA. But with the right support and a knowledgeable medical team, it is possible for people with axSpA to have successful pregnancies and a good experience caring for their newborns.

Axial spondyloarthritis is a condition that causes inflammation and chronic pain in the spine, pelvis, or other joints. It’s a broad type of spondylitis that includes radiographic axSpA (diagnosed when spinal damage is visible on an X-ray) and nonradiographic axSpA (when no damage is visible on X-ray). Some types of axSpA, such as ankylosing spondylitis, may cause fusing and damage to the sacroiliac joints that connect the spine and pelvis.

If you are pregnant or considering becoming pregnant and you have axSpA, it is essential to talk to your rheumatologist and your OB-GYN about your specific condition and how it might impact your pregnancy.

Conceiving When You Have Axial Spondyloarthritis

Axial spondyloarthritis itself does not impact your chance of getting pregnant. People with axSpA have a similar fertility rate as people without this condition. Keep in mind, however, that 12 percent to 15 percent of couples have difficulty conceiving after a year of trying, regardless of any known medical conditions.

If you are thinking about conceiving, talk to your health care team well in advance of your pregnancy. Your doctors can carefully work with you to develop a safe treatment plan prior to pregnancy, during pregnancy, and postpartum.

If either partner involved in conception has axSpA, their current treatment plans should be reviewed. A doctor can determine if any medications need to be adjusted due to their impact on fertility or pregnancy. They can also assess your disease activity.

Monitoring Disease Activity Prior To Becoming Pregnant

According to guidelines of the American College of Rheumatology, people with rheumatologic musculoskeletal diseases such as axSpA should aim for stable, low-level disease activity or no active disease for six months before becoming pregnant.

Because each person is different, it is important to talk to your doctors about your particular condition as early as possible in the pregnancy planning stages.

Adjusting Medication Before Pregnancy

Some drugs may need to be discontinued several months prior to pregnancy. For instance, it’s usually recommended that you stop taking methotrexate, which is commonly used in the treatment of inflammatory rheumatic diseases like axSpA, at least three months before becoming pregnant. It is associated with an increased risk of birth defects.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, may negatively impact fertility or pregnancy outcome and should be reviewed with your rheumatologist.

Sperm count may be affected by treatment as well. Some evidence has shown that people with axSpa who were treated with infliximab, a type of biologic drug, had reduced sperm counts. Lowered sperm counts can affect the ability to achieve pregnancy.

Some tumor necrosis factor (TNF) inhibitors — a type of biologic drug — may be considered safe during the first trimester of pregnancy.

Pregnancy Risks and Axial Spondyloarthritis Symptoms

Pregnancy may affect axSpA symptoms. It is important to understand the risks associated with pregnancy and axSpA, so you can work with your doctors to manage your condition as well as possible to reduce potential pregnancy risks and the risk of spondyloarthritis flares.

Most people with axSpA experience symptoms that stay the same or worsen during pregnancy. Pregnancy with ankylosing spondylitis, a severe form of axSpA, is associated with symptoms such as pain during the night, stiffness in the morning, and spinal pain and tenderness.

One study found that people with peripheral spondyloarthritis (affecting joints in the limbs) were more likely to experience improvement in symptoms during pregnancy than those whose disease was primarily in the spine. It is important to note that typical pregnancy symptoms, such as nausea, vomiting, fatigue, or general back pain, may also occur — starting in the first trimester.

In a study of 179 pregnancies in people with axSpA, disease activity was highest in the second trimester of pregnancy.

Pregnancy Complications With Axial Spondyloarthritis

Risk factors for pregnancy complications may depend on disease severity. One study showed that having ankylosing spondylitis, a more severe type of axSpA, increased the chance for complications during pregnancy, including preterm delivery and the need for delivery by cesarean section (C-section). Your rheumatologist or obstetrician may suggest working with a high-risk pregnancy specialist to help you manage these potential risks.

The risks may be different for those with early axSpA. One study of 381 pregnant women with early axSpA showed that 75 percent of their pregnancies resulted in full-term vaginal delivery.

Maintaining your treatment plan during pregnancy is essential. Having poorly controlled axSpA may raise the risk of premature delivery and having a baby with low birth weight, which can increase the chances for health problems in the newborn.

Treatment During Pregnancy

Some medications may be problematic during pregnancy, but others may safely decrease disease activity while pregnant. It’s important to talk to your rheumatologist about your medications prior to getting pregnant. Your specialist is the best person to help you weigh the benefits versus the risks of each treatment option. They can determine an appropriate treatment plan for you.

NSAID use during the third trimester is associated with a risk for low amniotic fluid and fetal injury. Some vaccinations, such as the flu shot and Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine, are generally recommended during pregnancy to protect the fetus against infection.

Stopping or switching medications during pregnancy may have unexpected consequences. Never stop or start a medication during pregnancy without medical advice from your rheumatologist and obstetrician.

Early Motherhood With Axial Spondyloarthritis

One study of 166 pregnant women with axSpA showed that in the postpartum period, axSpA disease activity remained low and stable for one year after delivery. Nonetheless, you may experience disease flares after giving birth, so it is important to work with your health care team to maintain your treatment regimen.

Along with managing your condition, your doctors will help ensure that all of your medications are considered safe for breastfeeding. Aspirin is generally avoided while breastfeeding. Most antirheumatic drugs used in the treatment of axSpA can be safely taken while breastfeeding. Follow whatever guidance your doctors give you.

While breastfeeding, do not take any drugs or supplements that you have not discussed with your health care providers. Some herbal or nutritional supplements may interact with medications in unforeseen ways.

The physical and emotional demands of caring for an infant can be challenging, regardless of any health conditions. Caring for an infant while living with axSpA presents additional challenges. Don’t hesitate to ask for the help you need from a partner, family members, and friends, or consider hiring professional caregivers.

Managing stress is also important with the demands of a newborn. Take breaks for yourself, when possible, and find time for healthy physical activity, rest, self-care, and relaxation. You can ask your doctor for a referral for a mental health counselor if stress becomes overwhelming.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 73,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Do you have more questions about axial spondyloarthritis and pregnancy? Share your experience in the comments below, or start a conversation by posting on your Activities page.