Pregnancy is filled with aches and pains for healthy women, but if you have osteoarthritis it can be even more challenging. Some of the normal symptoms of third trimester pregnancy include:
• Back ache
• Leaning backwards when walking
• Breathlessness due to less available space for the heart and lungs
• Swollen ankles due to the extra weight being carried
• Discomfort in the pelvis (common after your baby’s head has engaged)
Sometimes the hormone relaxin, which is released to loosen muscles and assist in the birth of the baby, causes the pelvis to move, which results in pain in the pubic bone, hip or thigh. This is called symphysis pubis dysfunction.
If you have osteoarthritis ("wear and tear" arthritis of the joints), pregnancy may unfortunately make your symptoms worse. This is because the extra weight from the baby puts extra strain on already damaged joints.
You may also have to stop taking your medications if they are not suitable for a developing baby.
Acetaminophen
It is considered generally safe at the recommended dosages, except if you have liver or kidney disease. There is research that showed babies born to mothers who took acetaminophen during pregnancy are more likely to develop increased wheezing. The results of a review of six studies showed a pooled increased risk of 21 percent in the medicated group. Although there were limitations in their study, since it did not specifically measure for asthma, the results warrant further investigation on acetaminophen use in pregnancy.
Non-Steroidal Anti-Inflammatory Drugs
These are drugs like aspirin and ibuprofen. Although they are NOT recommended for healthy pregnant women, they are sometimes used in pregnant women with osteoarthritis. They aren’t thought to affect the baby directly, but they can decrease the amount of fluid around the baby. They can also make it difficult for women to get pregnant.
If you are taking anti-inflammatories, they should be stopped at 32 weeks of pregnancy because if they are taken after that they may cause a vessel in your baby’s heart to close early. This vessel usually closes at birth, which re-directs blood and allows the baby to get oxygen from its lungs instead of the placenta. Aspirin does not affect the baby’s heart.
Anti-inflammatories can also cause problems with the delivery, including lengthening the labor and triggering haemorrhage.
Steroid Injections
These are used commonly in pregnancy, usually to mature the lungs of an infant who will be born prematurely. If you have high doses of steroid during pregnancy you should take calcium and vitamin D supplements to prevent the occurrence of osteoporosis.
Disease-modifying anti-rheumatic drugs (DMARDs)
Some of these are unsafe during pregnancy and you may need to stop them for up to two years before you attempt to become pregnant (for instance, leflunomide needs to be ceased two years prior to conception because it causes birth defects). Others cause miscarriage, disability in the baby or infertility problems. Some have been taken by pregnant women who have gone on to have healthy children. Please see your doctor to discuss your medication before you attempt to get pregnant.
General Anaesthetics
Up to 2 percent of women in developed countries have general anaesthesia during their pregnancy, for non-obstetric reasons. Unborn babies who are exposed to general anaesthetics in the womb are at greater risk of miscarriage, intrauterine growth restriction and low birth weight.
If you are having a steroid injection for osteoarthritis this is usually done under a general anaesthetic then your doctor may opt to give you a local anaesthetic instead, as wherever possible, local anaesthetics will be used to minimize risk to the fetus.
In cases where there is no other option, anaesthetics should ideally not be given until the second trimester.
Alternative Treatments
Glucosamine
There is currently no evidence that glucosamine is harmful to an unborn baby, but this may be because there have been limited studies of the supplement and pregnant women are generally advised to avoid it.
Of 54 women who took glucosamine during pregnancy, there were 50 live births (including two sets of twins), four miscarriages, one abortion and one stillbirth with no deformities. The researchers concluded: ‘These limited data suggest no increased risk for major malformations or other adverse fetal effects following the use of GLS during pregnancy.’
Ginger
This spice is used to treat arthritis and is also used to treat morning sickness and is considered generally safe for use in pregnancy. There is some concern that ginger might affect the sex hormones of the fetus and there has been one report of a 12 week miscarriage in a woman who was using ginger to treat morning sickness. However, studies show that ginger can be used without causing any harm to the fetus.
Turmeric
Turmeric supplements have been used to treat osteoarthritis, but they should not be used in pregnancy. If you want to use turmeric, you can have it in food as it is safe for pregnant women to eat.
Cherry Powder Extract
This has been shown to be beneficial in reducing pain associated with osteoarthritis and reduced pain for more than half of patients in a Baylor Research Institute study. The supplements aren’t recommended in pregnant women because they haven’t been studied, but pregnant women can safely eat cherries and drink cherry juice for the same effect.
Capsicum (Hot Pepper Ointment)
Capsicum ointments that you rub into the affected joints have been rated as likely safe for use in pregnant women.
If in doubt about any medication use during pregnancy, ask your obstetrician or midwife.
Sources:
Pregnancy and arthritis, Home Page Arthritis Research UK. Web. 17 August 2011.
http://www.arthritisresearchuk.org/arthritis_information/arthritis__daily_life/pregnancy_and_arthritis.aspx#non
Paracetamol in Pregnancy linked to asthma - Health News - NHS Choices, NHS Choices - Your health, your choices. Web. 17 August 2011. http://www.nhs.uk/news/2011/03March/Pages/paracetamol-pregnancy-asthma-link.aspx
Anaesthesia for non-obstetric surgery during pregnancy, Oxford Journals | Medicine | BJA: CEACC. Web. 17 August 2011. http://ceaccp.oxfordjournals.org/content/6/2/83.full
Glucosamine use in pregnancy: an evaluation of pregnancy Outcome, National Center for Biotechnology Information, Web. 17 August 2011. http://www.ncbi.nlm.nih.gov/pubmed/17439379
Ginger: MedlinePlus Supplements, National Library of Medicine - National Institutes of Health. Web. 17 August 2011.
http://www.nlm.nih.gov/medlineplus/druginfo/natural/961.html
Turmeric, University of Maryland Medical Center | Home. Web. 17 August 2011. http://www.umm.edu/altmed/articles/turmeric-000277.htm
Can Cherries Relieve The Pain Of Osteoarthritis? Science Daily: News & Articles in Science, Health, Environment & Technology. Web. 17 August 2011. http://www.sciencedaily.com/releases/2009/03/090319164327.htm
Natural Herbs & Vitamins During Pregnancy : American Pregnancy Association, Promoting Pregnancy Wellness : American Pregnancy Association. Web. 17 August 2011. http://www.americanpregnancy.org/pregnancyhealth/naturalherbsvitamins.html
Acerola : Information on Uses, Dosage & Side Effects on Healthline.com, Medical Information for Healthy Living | Healthline. Web. 17 August 2011. http://www.healthline.com/natstandardcontent/acerola
Reviewed August 18, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting, in addition to running a charity for people damaged by vaccines or medical mistakes.