Pregnancy with Ankylosing Spondylitis


Does ankylosing spondylitis (AS) worsen with pregnancy?

Pregnancy tends to improve AS in 20-30%, worsen AS in 20-30% while it remains unchanged in 50-60%. In general, spinal disease remains unchanged during pregnancy while peripheral arthritis and uveitis are suppressed during gestation and tend to exacerbate after delivery. Women carrying a female foetus fare better than those carrying a male foetus. Those with active spinal disease are advised not to plan pregnancy unless the disease is controlled.

When can one plan pregnancy with ankylosing spondylitis?

Your arthritis must be reasonably controlled for a period of at least 3-4 months before planning pregnancy. You should not have had any flare during these months.
Always speak to your Rheumatologist before planning pregnancy as he may have to make changes in your medicines. He would be the best person to guide you regarding the timing of your decision. Please speak to him well in advance as Methotrexate has to be stopped at least 3 months prior to planning to conceive.Those with active spinal disease are advised not to plan pregnancy unless the disease is controlled.

Is the pregnancy outcome different in patients with ankylosing spondylitis?

No. Ankylosing spondylitis doe not affect the course of pregnancy or the fetal well-being. The risk of fetal loss, prematurity or low birth weight does not increase with AS. Women with Ankylosing spondylitis are more likely to require a cesarean section as inflammed/ ankylosed sacroiliac joint is a mechanical hindrance to childbirth.

What to expect after delivery?

50-80% of the AS patients experience aggravation of symptoms 4 to 12 weeks after delivery. Episodes of uveitis & peripheral arthritis are more common after delivery.

Does Ankylosing spondylitis impair fertility?

No. Ankylosing spondylitis does not impair fertility. Sulfasalazine can impair the maturation of sperm cells and thereby impair the fertility of men. However, this generally settles after stopping the medicine (after an average of 2 ½ months). Sulphasalazine does not affect fertility in women.

Does Ankylosing Spondylitis start during pregnancy?

Ostenson & colleagues studied 939 patients & found that AS starts during pregnancy in about 21% patients.

What is the risk of your child inheriting AS?

The risk of your child inheriting AS is higher if you are HLA-B27 positive. If you are HLA-B27 positive & your partner negative; the chance of your child being positive is 50%. However that does not mean that he/ she has to develop AS. The chances of developing AS are even lower; probably 5- 20%. The chances are higher If you have any other family members affected by AS.

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