Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases

The Norwegian National Advisory Unit on Pregnancy and Rheumatic diseases (NKSR) purpose is to possess and spread updated knowledge regarding the period before, during and after pregnancy in patients with rheumatic diseases. NKSR’s primary task is to spread knowledge to all regional health authorities to ensure that patients have equal access to current best practice health care. NKSR contributes to research, heightening competency and academic development, and thereby improving national knowledge on this topic. NKSR arranges courses and teaches at all academic levels throughout the country. Both health care workers and patients can contact NKSR by phone for advice and guidance.

Rheumatic diseases and pregnancy

Here below you can find information about rheumatic diseases and pregnancy for patients in English.

Lupus and connective tissue diseases

Many women with lupus experience normal pregnancies, but there may be complications during pregnancy, and it is important to be aware of this.

Pregnancy in women with connective tissue disease should be well planned and prepared. Women with active lupus should see specialized doctors for controls (rheumatologist, gynaecologist, nephrologists, cardiologist, and haematologist) at regular intervals during their pregnancy.

Disease activity in women with lupus may vary in pregnancy in the same way as before pregnancy. Around fifty per cent of pregnant women with lupus experience acute flare that needs treatment during pregnancy. Symptoms may be swollen or tender joints, skin rash or fatigue. Women with lupus also experience normal pregnancy symptoms that are not related to their lupus. Normal changes related to pregnancy can be fluid retention, swollen joints, rash and hair loss.

The disease should be in remission and stable for at least six months before trying to get pregnant. Since active lupus nephritis is a risk factor for both mother and foetus, it is very important that this is stabile and inactive.

About one third of women with lupus experience a reduction in blood platelets, thrombocytes, that makes it necessary to start medical treatment.

20 per cent may experience protein in the urine, and this can be a sign of nephritis. Increased blood pressure and protein in urine can also be a sign of preeclampsia. Regular doctor/midwife appointments are important to look for any signs of preeclampsia.

During pregnancy the disease need to be monitored by rheumatologist with monthly controls during the first and second trimester. More frequent controls are necessary in the last trimester or if there are any signs of flare.

Women with antiphospholipid antibody syndrome (previous thrombosis, spontaneous abortions and positive antiphospholipid antibody syndrome blood tests) will need preventive treatment with blood thinners.

Women with lupus are offered early ultrasound in pregnancy week 12 in Norway.

Women with auto antibodies called anti-SSA/SSB should be monitored weekly/every 14 days with ultrasound of the foetus heart rhythm from pregnancy week 16-26 to reveal any threatening rhythm disorder as early as possible.

Today we know that pregnancy in women with lupus is not as high risk at we previously thought, and around fifty per cent have normal deliveries and healthy babies.

 

Psoriatic Arthritis

Women with psoriatic arthritis often experience improvement of their disease activity in pregnancy.
Skin rash is expected to get better in pregnancy. Brief flares can however be expected, especially in the first trimester and around pregnancy week 20. The disease has no influence on the pregnancy, the foetus or the newborn baby.

A flare after delivery may be expected within 2-6 months.


 

Juvenile Idiopathic Arthritis

Approximately half of the women with juvenile idiopathic arthritis have inactive disease in adulthood. If these women get pregnant, it is not expected that they will experience change in disease activity.

Most women who have active disease in adulthood, can also expect improvement during pregnancy. This is particularly so for the women who have had disease activity only in a few joints and only sporadically.

Approximately 10 per cent of the women with juvenile idiopathic arthritis have active disease during pregnancy, and will be in need of drugs.

Around 50 per cent of the women with juvenile idiopathic arthritis experience a flare of their disease within 2-6 months after delivery. Women who have had inactive disease in adulthood can also experience this flare. The flare is expected to be temporally, and the disease activity usually stabilizes within the first year after delivery.


 

Rheumatoid arthritis

Pregnancy can affect women with rheumatoid arthritis in different ways. It is unknown why someone experience low disease activity and others high disease activity during pregnancy.

About 75 per cent of the women with rheumatoid arthritis experience significant improvement of symptoms during pregnancy and the majority of them experience this improvement within their first trimester. This improvement normally lasts throughout the pregnancy. About 20 per cent experience no change in disease activity, and 5 per cent experience a flare.

If a patient experienced improvement in regards to disease activity in a previous pregnancy, it’s likely that the disease will act similarly also in following pregnancies.

The majority of patients with rheumatoid arthritis experience a flare after delivery. Within the first 3-4 months a flare occur in up to 60 per cent of the patients. The disease activity will normally stabilize, and return to the pre pregnancy state within the first year after delivery.


 

Spondyloarthritis


Most women with spondyloarthritis experience the same disease activity during pregnancy as before they got pregnant. There are good and bad days.

Approximately half of the women with spondyloarthritis experience that pregnancy has little influence on disease activity. 20 per cent of the women feel better from their disease in pregnancy; this is most common for the women that also have peripheral arthritis related to their spondyloarthritis. Around 20 per cent of the women experience more back- and joint pain in pregnancy. This period with increased pain usually starts around pregnancy week 20.

Take in consideration that the back- and joint pain may feel more intense when normal pregnancy symptoms such as nausea and vomiting, or pelvic pain appears.

It’s important for women with spondyloarthritis to stay physical active during their pregnancy. The women will benefit from physiotherapy or a training program that is tailored for the patients specific needs during pregnancy.

Around half of the women with spondyloarthritis experience increased disease activity after delivery. This increase in disease activity usually last for 2-6 months and the disease activity is expected to stabilize within the first year after delivery

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