Pregnancy and Arthritis
An Information Booklet
About this booklet
The aim of this booklet is to help people with arthritis who are thinking about having a baby or have just found out that they are pregnant.
The general information in this booklet applies to most forms of arthritis, but there is a separate section for people who have lupus (systemic lupus erythematosus or SLE). This is because this disease behaves differently in pregnancy from other types of arthritis (see 'Lupus (SLE) and pregnancy').
The booklet describes the effect of the pregnancy on your arthritis and the effect of your arthritis on the pregnancy and the baby. Of course, each pregnancy is different and the effects of arthritis vary from person to person, so it is only possible to give fairly general information. You should ask your doctor for more specific advice, preferably before trying for a baby.
At the back of the booklet you will find information on how to contact the Arthritis Research Campaign (arc). There is also a brief glossary which explains medical or technical words. We have put these in italics when they are first used in the booklet.
Starting a family
Introduction
When any couple starts to think about having a baby they naturally want to do all they can to have a normal healthy baby, and most couples also worry about the risk of the baby being born with abnormalities. It is no different if you have arthritis. If you plan your pregnancy and let the doctors and nurses know you are thinking of having a baby, you will improve your chances of a normal pregnancy and baby. Planning is important because of the drugs you are likely to be taking.
It is important for both partners to be fully aware of the risks and problems associated with pregnancy. Coping with a newborn baby and during the subsequent childhood requires love, time and commitment from both partners, especially when one partner has arthritis.
When is the best time to have a baby?
You are likely to have good and bad times with your arthritis. It is always better to try for a baby while you are in a good phase. This will allow you to reduce the drugs you need to take during the pregnancy. Some recent studies suggest that non-steroidal anti-inflammatory drugs (NSAIDs) taken around the time of conception may increase the risk of miscarriage, so you might want to discuss the risks with your doctor. (Note that paracetamol has not been linked with an increased risk of miscarriage.)
Some drugs you are taking for your arthritis may have to be stopped before conception. This may cause your arthritis to get worse. You must not become pregnant or try to father a child while you are on methotrexate, cyclophosphamide or leflunomide (see the section 'Drugs, pregnancy and breastfeeding'). Other drugs are safe to take in this period and your doctor will be aware of these. It should also be possible to get help in the form of other measures, such as physiotherapy and acupuncture.
It is also important to discuss with your doctor well in advance the risks associated with pregnancy. As you get older (over 35 years) it may be harder to get pregnant. If you wait until you are over 40 you may be more likely to miscarry, and there will be a greater risk of having a baby with a problem such as Down's syndrome.
Preparing for pregnancy
Any couple trying for a baby should stop smoking. This will reduce the chance of having a small baby (due to growth retardation) and will also reduce the risk of cot death. You should also cut down the amount of alcohol you drink and preferably stop taking any recreational drugs you may use.
If you are overweight this will make it harder for you to become pregnant and make you more likely to develop diabetes during pregnancy. So try to lose some weight before you get pregnant. This will help your joints as well.
What supplements should I take?
All women who want to have a baby should take a folic acid tablet (0.4 milligrams) every day from 3 months before the time of conception until 12 weeks into the pregnancy. This is particularly important if you have ever been given methotrexate to treat your arthritis as this drug can affect your body's supply of folic acid (see 'Drugs, pregnancy and breastfeeding'). This will reduce the risk of having a baby with a defect in the spinal canal (spina bifida). You can get folic acid from supermarkets, health food shops or chemists.
With the exception of folic acid and iron supplements you should avoid all other supplements unless a specific deficiency, such as lack of vitamin D, is found. Asian women may be particularly susceptible to vitamin D deficiency due to low exposure to sunlight and a diet which is low in this vitamin (see arc booklet 'Osteomalacia (Soft Bones)').
If you are taking steroids during pregnancy you may also be advised to take calcium and vitamin D tablets to help protect your bones from thinning (osteoporosis).
Should I stop all my drugs before becoming pregnant?
You should never stop taking prescribed drugs without talking to your doctor. If you tell your doctor you want to become pregnant then s/he can help to get you onto the safest combination of medication at the lowest reasonable dose to reduce the risk of the tablets causing problems. (See 'Drugs, pregnancy and breastfeeding'.)
If I'm a man does it matter what drugs I am taking?
While many women remember to talk to their doctors about starting a family the same advice should apply to men. Some drugs you may be taking, such as methotrexate, sulfasalazine or azathioprine, can reduce your sperm count, and methotrexate can also cause miscarriage or abnormalities such as spina bifida. You will therefore be advised to stop these drugs well before trying to father a child. Further recommendations are given in the section 'Drugs, pregnancy and breastfeeding'.
You can help improve your sperm count by eating a healthy diet, stopping or cutting down your smoking, and reducing your alcohol and caffeine intake. Remember that caffeine is not just in coffee but also in tea, coke, Red Bull and many other soft drinks.
During the pregnancy
What tests will I have during pregnancy?
An ultrasound scan, to check for abnormalities in the baby, is done in all pregnancies at 18–20 weeks. The doctors choose this time because the baby is bigger and it is easier to find any problems then. Some problems can be quite minor. If any problem is found at your 20-week scan, the doctors and midwives will talk to you about it and discuss the implications and options available to you. More detailed scans may be necessary if, for example, you have taken tablets or drugs during the pregnancy that may cause particular problems.
Sometimes you may need two or three scans before the doctors can see everything clearly, but this does not necessarily mean that there will be a problem. Sometimes the parts that we are trying to see may be hidden, for example, by the baby's hand. So do not worry if everything cannot be seen clearly at first and you are asked to return for a second scan.
Will I be able to do my exercises?
Yes. It is important for your arthritis to keep exercising for as long as possible during the pregnancy. As your pregnancy advances and you gain weight you may find it easier to do your exercises in the swimming pool where the water will help to support your weight.
Arthritis and pregnancy
Will the pregnancy affect my arthritis?
The effect of pregnancy on arthritis varies with the type of arthritis. The good news is that most women with rheumatoid arthritis will be free of flare-ups during pregnancy. The arthritis will return after the baby is born, though, so unfortunately it is not a 'cure'.
The effect of lupus (SLE) on pregnancy is outlined in the separate section 'Lupus (SLE) and pregnancy'. Other disorders, such as ankylosing spondylitis, may improve or become worse – there is no consistent pattern.
If you have osteoarthritis, particularly of the knee or hip, the increase in your weight as the baby grows may cause you problems.
Most women get aches and pains, particularly backache, in pregnancy and it is likely that you will too.
Will the arthritis affect my pregnancy?
Types of arthritis other than lupus do not harm the baby, or increase the risks of any problems in pregnancy. However you must always take care about the drugs you take while you are pregnant, as they can sometimes affect the pregnancy. See the 'Drugs, pregnancy and breastfeeding' section for a list of the common drugs taken and what we know about their effects during pregnancy.
Will the arthritis affect my labour?
No, you should have a normal labour. If you have a lot of problems with your back, for example if you have ankylosing spondylitis, it may be a good idea to talk to an anaesthetist about whether they would advise you to have an epidural for pain relief. This can be arranged during the pregnancy, well before the time of labour. Even if you cannot have an epidural, the anaesthetist will tell you about the many other options that are available.
For arthritis in general, there are many different positions in which you can give birth. If you have difficulty because you cannot move your legs enough in one position, the midwife will discuss with you in advance other positions which may be better.
What are the chances of my child having arthritis?
The chances vary depending on the type of arthritis you have (see below). With most forms of arthritis, the chances of passing it on to your children are not very high, and there are many other factors involved in the development of arthritis apart from simply the genes inherited from the parents – for example, chance itself, joint injury, certain occupations, smoking, being overweight, and environmental triggers. For lupus, please see the separate section 'Lupus (SLE) and pregnancy'.
Osteoarthritis
Most forms of osteoarthritis do not have a strong tendency to be passed on from parent to child. That is, in most forms, heredity plays a relatively small role compared with other factors such as age, joint injury or being overweight.
However, one common form of osteoarthritis which does run strongly in families is nodal osteoarthritis. This mainly affects women and causes firm knobbly swellings, called Heberden's nodes, on the joints at the ends of the fingers. Nodal osteoarthritis also often causes a swollen thumb base – that is the joint at the very bottom of the thumb, just above the wrist. Nodal osteoarthritis is almost entirely confined to white people. (See arc booklet 'Osteoarthritis'.)
Nodal osteoarthritis often does not start until the 40s or 50s, around the time of the menopause, so you may not develop it while you are of child-bearing age. If your own mother has nodal osteoarthritis, and you are female, you have about a 1 in 2 (50%) chance of inheriting it yourself. And if you have inherited it, your daughters would have a 1 in 2 (50%) chance of developing nodal osteoarthritis themselves in middle life.
Rheumatoid arthritis
Although there is some tendency for rheumatoid arthritis to cluster within families, the tendency to pass it on from parent to child is not very strong. The likelihood of a first-degree relative (parent, brother, sister or child) of someone with rheumatoid arthritis having the disease is increased about threefold compared with the population at large. This makes the risk of a child of someone with rheumatoid arthritis developing the disease around 1 in 30 (about 3%) so they are far more likely not to get it than to get it. (See arc booklet 'Rheumatoid Arthritis'.) At present, information on inherited factors in arthritis is still relatively limited, but research is continuing in this area.
Ankylosing spondylitis and HLA-B27
If you have the HLA-B27 (human leucocyte antigen B27) blood cell type, you are more likely than other people to develop ankylosing spondylitis. However, about 7–10% of healthy people have HLA-B27 and never develop the disease, so this blood cell type does not automatically lead to the disease. (See arc booklet 'Ankylosing Spondylitis'.)
If you have ankylosing spondylitis, and you are HLA-B27 positive, the chances of passing HLA-B27 to your child are 1 in 2 (50%). The risk of an HLA-B27 relative developing ankylosing spondylitis is about 1 in 3 (33%). Therefore the overall risk of your children developing ankylosing spondylitis in adulthood is about 1 in 6 (16%). However, when ankylosing spondylitis occurs in a family where other members have it, it tends to be less severe than when there is no apparent family link. Other conditions are also associated with HLA-B27 (see below).
HLA-B27 and other conditions
There are other conditions which are also associated with HLA-B27, including psoriatic arthritis and reactive arthritis. However, these are less strongly linked with HLA-B27 than ankylosing spondylitis.
Lupus (SLE) and pregnancy
Will the pregnancy affect my lupus?
It is difficult to give advice that is appropriate for everyone as lupus can vary from mild to severe. Some people with severe lupus may be advised against having a baby as pregnancy can put an enormous strain on your heart, lungs and kidneys. For other women it may be safe to proceed under careful supervision. It is always best to discuss this with your doctor or rheumatology nurse specialist before conception.
The good news is that most women with lupus who become pregnant will do so during a quiet phase or 'remission'. You may stay in remission or get flare-ups during pregnancy. However, some types of flare-ups (those involving the skin and joints) tend not to occur towards the end of pregnancy.
There are many drugs that can be safely used in pregnancy to treat your flare-ups. These include steroids and a drug called immunoglobulin, but others have also been used successfully (see 'Drugs, pregnancy and breastfeeding').
Will the lupus affect my pregnancy?
Most women with lupus will have a successful pregnancy. However, some do have a higher risk of complications during pregnancy. This will mean close monitoring at the hospital, and your obstetric consultant will need to see you frequently in the antenatal clinic. Miscarriage affects between 1 in 4 (25%) and 1 in 5 (20%) of all pregnancies in the general population, so it is very common. There appears to be an even higher risk if you have lupus. The miscarriage may also be slightly later than the 'normal' miscarriage (which usually happens by 12 weeks) – up to 24 weeks if you have antiphospholipid syndrome. For details of antiphospholipid syndrome in people who do not have lupus, see the separate arc booklet 'Antiphospholipid Syndrome'.
It is preferable if the pregnancy is planned, as this will allow your lupus specialists and the obstetric team to work closely together. It may be that they advise you not to have your baby at your local hospital but at a more specialist site where they can work better as a team to help you. It is important to be in a hospital that is able to look after very small babies. This means that a baby born early or very small will have the best chance of surviving.
You and your baby will be checked more often than most women during pregnancy. You will have regular scans to check how your baby is growing. The medical team will also use other ways of monitoring your baby which may include taking regular traces of its heartbeat and checks on the blood flow to the womb and the umbilical cord (using ultrasound scans). Your blood pressure and urine will also be checked.
You must always take care about the drugs you take in pregnancy. However, the risk of a problem to the baby may be greater if you do not take the drugs or if you stop them suddenly.
What types of problem can happen with lupus later in pregnancy?
- Your blood pressure may increase (pre-eclampsia) so regular checks are necessary. High blood pressure can cause severe headaches and visual disturbances, so you should consult your doctor if you develop these symptoms during pregnancy.
- Your baby may not grow as fast as normal (growth retardation).
- Your waters may break much earlier than usual or you may go into labour early (pre-term delivery).
There is some evidence that a low-dose aspirin tablet taken every day can reduce the risk of you developing some of these problems. Your doctor will discuss this with you when you first go to the antenatal clinic.
There is a greater risk that these problems will occur if your kidneys are affected by the lupus and you already have high blood pressure before the pregnancy.
The problems listed above are also more likely if blood tests show that you have antiphospholipid syndrome. Women with this condition will usually see a consultant with a particular interest in 'high-risk' pregnancies (see arc booklet 'Antiphospholipid Syndrome'). You will be given a low-dose aspirin tablet every day, but you may also need daily injections of a blood-thinning drug (anticoagulant) called heparin. This does not cross the placenta so it does not affect your baby. You can easily be taught to give this injection yourself.
Will the lupus affect my labour?
No, you should have a normal labour like most women. However, if you go into labour too early, the doctors may try to stop you labouring, with drugs, to allow more time for the baby's lungs to mature. Because you have a greater risk of problems during your pregnancy, the doctors may sometimes feel that it is safer (for you or for the baby) if your baby is delivered by Caesarean section. This would be discussed with you during the pregnancy well before the time of labour.
Will the lupus affect my baby?
There is an increased risk of babies born to mothers with lupus being smaller than usual at birth. If this happens, your baby may need to spend a few days in the newborn (neonatal) nursery. If the baby is born very early, s/he will spend longer in the nursery and may need help initially with breathing.
If you carry Ro antibodies in your blood, there is a chance that your baby's heartbeat may become slow. This problem develops during the pregnancy and continues after the birth (this is called congenital heart block). Only a few women with these antibodies will have this problem, but your doctor will carefully monitor your baby's heartbeat during the pregnancy to check for it. It is possible that steroid tablets may help prevent this complication, but medical trials are still under way. Babies affected in this way usually do very well, but some babies may need to have a heart-pacing device inserted after birth.
What are the chances of my child having lupus?
There is a small chance of your child developing lupus in later life if you have it yourself – perhaps 1 in 100 (1%) altogether.
Because of the way the genes involved work, there is actually a greater risk of other relatives developing the disease. For example, the risk of developing the disease if you are the sister of someone with lupus is about 1 in 33 (3%). The risk is lower for brothers.
After the birth
How will I cope with the new baby?
Coping with the demands of a small baby is exhausting for any new mother, and for a woman with arthritis the stresses can be much greater. For example, people with rheumatoid arthritis may find that their arthritis flares up again in the weeks after the birth (often after going into remission during the pregnancy) and this can obviously make things more difficult. You should try to counteract this by arranging beforehand for extra help from family and friends once the baby is born. If necessary, extra help can be arranged – discuss this with your doctor or with social services.
Following the birth, a physiotherapist and occupational therapist may need to be involved in the aftercare, as holding, dressing, washing and feeding a baby – particularly night feeds – can all be difficult because of stiffness. Your doctor should be able to tell you whether you can get help of this sort and how to go about it. If you already have another small child or children, you will need to arrange for extra help in caring for them. Extra support from a partner, other family members or friends is crucial in sharing the care of a small baby, while help from extended family and social services will all help you cope in the first few months after the birth.
Having a small child can be hard work, even with help from a committed partner and other family members. But many women with arthritis, including rheumatoid arthritis or lupus, are still capable of having children and can often do so without too many problems.
What about my medication?
If your drugs for arthritis were stopped before or during the pregnancy most doctors recommend going straight back on to them. This applies except where the drugs would stop you breastfeeding (see below). Because of the benefits for the baby of breastfeeding, at least for the first few weeks, in the case of certain drugs some women prefer to wait until the arthritis flares up again before returning to their medication. Ask your doctor or rheumatology nurse specialist for advice on this.
If you have a flare-up during the time after the birth, perhaps before the disease-modifying anti-rheumatic drugs (DMARDs) have had a chance to start working again, then your doctor may give you a short course of steroids. If only one or two joints are troublesome these can be safely injected with steroids. Other measures that may be of use include physiotherapy.
Will I be able to breastfeed?
Yes. Breastfeeding is best for your baby so the doctors and midwives will try very hard to keep you on drugs that will not affect your baby through your milk. Even if you only breastfeed for a few weeks it will give your baby a better start in life. Drugs you are taking while breastfeeding may pass into the breast milk, although in small amounts, so it is sensible to take as few drugs as possible.
Many drugs (particularly many of the DMARDs such as ciclosporin, gold injections, cyclophosphamide, methotrexate, and leflunomide) must not be taken at all while breastfeeding – if these drugs are necessary then the baby should be bottle-fed. Sulfasalazine and hydroxychloroquine have been used successfully in women who were breastfeeding.
If you are taking steroids, small amounts are excreted in breast milk, but no side-effects on babies have been reported.
Most NSAIDs do not enter the breast milk in large quantities, except high-dose aspirin and this should be avoided. Drugs such as ibuprofen, indometacin and diclofenac can be used but doses should be kept to a minimum.
See the section 'Drugs, pregnancy and breastfeeding' below, the separate arc leaflet 'Drugs and Arthritis' and the individual arc leaflets on each drug type.
Drugs, pregnancy and breastfeeding
Introduction
Every couple hopes that they will have a perfect baby. In an ideal world the process of having children, from conception to breastfeeding, would be drug-free. This is because we can never be 100% sure that the drug will be harmless to the developing child. In fact, most drug manufacturers and the arc drug information leaflets recommend avoiding drugs during pregnancy or while breastfeeding – but this is not the same as saying that the drug will definitely harm your baby. In order for the pregnancy to have a successful outcome, for both mother and baby, sometimes drugs are essential. This is the case for many of the drugs used in people who have arthritis. The following sections provide a summary of what we know about the effects of these drugs during pregnancy and while breastfeeding. In some cases there is only limited information available, but we do know that, for most drugs, many pregnant or breastfeeding women will take them without any problems. Because everyone is different we would strongly recommend that you discuss each drug you take with your doctor or specialist before you try to become pregnant.
Paracetamol
Strictly speaking, paracetamol, like most drugs, is not recommended for use during pregnancy or while breastfeeding. However, it is a good form of pain relief and is frequently used by women who are pregnant or breastfeeding without causing any problems. Most women can take the usual dose, even during pregnancy, but if your kidneys are not working properly you may be told to use a lower dose.
Non-steroidal anti-inflammatory drugs (NSAIDs)
The NSAIDs include aspirin, ibuprofen and indometacin.
NSAIDs may reduce the amount of fluid in the womb surrounding the baby, but they do not cause abnormalities in the baby. As previously mentioned, some studies suggest that NSAIDs may increase the risk of miscarriage if taken around the time of conception.
Large doses of NSAID tablets given to women towards the end of pregnancy may cause a blood vessel in the baby's heart to close early, while the baby is still in the womb, rather than at birth. (This blood vessel is the one which redirects the baby's blood to allow it to get oxygen from its lungs, rather than from the placenta.) If this does happen, the problem will usually resolve completely if the NSAID tablets are stopped. Nevertheless, it is best to be on the lowest dose of NSAID tablets that will keep your symptoms controlled. You may be asked to reduce or stop your NSAIDs towards the end of pregnancy for this reason. NSAIDs might also be stopped during delivery as they may prolong the labour and cause excessive bleeding during delivery. Please note that the 'low-dose' aspirin tablets taken throughout pregnancy by women with lupus do not affect the delivery or the blood vessel in the baby's heart.
A common problem with NSAIDs is indigestion, which is also common in pregnancy. Antacid medication usually helps, but if it is very troublesome you should tell your doctor.
Most NSAIDs do not enter the breast milk in large quantities, but high-dose aspirin should be avoided while breastfeeding.
Corticosteroids ('steroids')
These are often used in pregnancy. There is no evidence that steroids harm your baby and doctors often give them during pregnancy to help the baby's lungs to mature (usually when labour begins before 34 weeks). The steroids may slightly increase the risk of you developing diabetes of pregnancy (high blood sugar levels). This is easily detected by checking your urine sample, and the problem usually goes away again when the steroids are stopped.
If you have been on high doses of steroids for a long time you may be given an extra boost of steroids during labour to help your body cope with the stress of labour. This is routine for anyone taking high-dose steroids for a long time. Women taking steroids throughout pregnancy are sometimes advised to take supplements of calcium and vitamin D to help prevent osteoporosis. Steroids are excreted in small amounts in breast milk, but no side-effects have been reported in breastfed babies.
Disease-modifying anti-rheumatic drugs (DMARDs)
Azathioprine
This can lower the sperm count in men and may affect the eggs in women. Many women who have had kidney (renal) transplants take azathioprine and, so far, they appear to go on to have normal babies with no increase in the risk of abnormalities. However, azathioprine is not normally recommended during pregnancy or while breastfeeding.
Ciclosporin
Ciclosporin is used widely in people who have had transplants as well as for arthritis, and many women who have used the drug have had successful pregnancies. However, the drug is excreted in breast milk and bottle-feeding is therefore advised.
Cyclophosphamide and chlorambucil
Cyclophosphamide and chlorambucil can cause sterility, in men and women. Men having these treatments may be advised to collect and 'bank' sperm for future fertility. These drugs should be stopped at least 3 months before trying for a baby, and should be avoided during pregnancy as they are likely to be harmful. Bottle-feeding is recommended if you need to take this drug after the baby is born.
Gold injections
Gold injections do not appear to affect fertility. Although the drug does cross the placenta, there have been no reports of this harming the baby. Gold is excreted in the breast milk and may cause a rash and kidney problems in the baby, so women who wish to continue with this drug should bottle-feed.
Hydroxychloroquine
This drug is frequently taken to prevent malaria as well as for arthritis and so far it does not appear to increase the risk of birth abnormalities even in higher doses. It has been used successfully during pregnancy by women with lupus.
Leflunomide
This drug is a relative newcomer in the treatment of rheumatoid arthritis. Leflunomide may cause birth defects and should be avoided before and during pregnancy. Reliable contraception should be used when taking this drug. Leflunomide stays in the body for a long period of time and women wishing to have a baby should allow at least 2 years from stopping this drug before trying to become pregnant. For this reason doctors sometimes avoid using it in women who may want a pregnancy. The waiting period can be reduced to 3 months if you have a special treatment to 'wash out' the leflunomide from your body. Men should stop taking the drug, have the 'wash out' treatment, and then wait 3 months before trying to father a child. Leflunomide should not be used while breastfeeding.
Methotrexate
This affects both eggs and sperm. It can also cause miscarriage, or abnormalities such as spina bifida in the unborn baby. Reliable contraception is therefore essential while you are on methotrexate (whether you are male or female). Methotrexate must not be taken while you are pregnant or breastfeeding, and should be stopped at least 3 months (although some doctors recommend up to 6 months) before you try to become pregnant or to father a child. If you do become pregnant while on methotrexate, you should speak to your doctor as soon as possible.
Penicillamine
A number of women have had successful pregnancies while taking this drug. However, there is a risk that it could cause problems if taken in high doses in early pregnancy, and it is not generally recommended.
Sulfasalazine
This can cause a low sperm count, but this is reversible. If a man has difficulty trying to start a family it might be better changing to another treatment. Many women have used the drug successfully during pregnancy and while breastfeeding.
Biological therapies
The biological therapies include adalimumab, anakinra, etanercept and infliximab. They are all relatively new drugs used in the treatment of rheumatoid arthritis, and there is therefore little experience of their effects either during pregnancy or while breastfeeding. The drugs should be stopped 5–6 months before trying to become pregnant or to father a child. The drugs may pass into the breast milk and the effects on the baby are not yet known. When people are given infliximab they are usually given methotrexate as well, so the advice relating to methotrexate and pregnancy will also apply.
Glossary
Antibodies – blood proteins which form to help the body fight off germs, viruses, or other harmful substances. In some diseases, antibodies (known as autoantibodies) may attack the body's own tissues instead. Ro antibodies are a particular type of autoantibody, found in lupus and also in a disease called Sjögren's syndrome, which have been associated with congenital heart block. (See 'Will the lupus affect my baby?' above and the separate arc booklets 'Lupus (SLE)' and 'Sjögren's Syndrome'.)
Antiphospholipid syndrome (APS) – a disorder in which the blood has a tendency to clot too quickly ('sticky blood' syndrome). The clotting can affect any vein or artery in the body, resulting in a wide range of symptoms. It is caused by an antibody which 'attacks' phospholipids. Phospholipids are found throughout the body, particularly in the outer coating of cells, such as the white blood cells called platelets. Because the antibody attacks the body's own cells, rather than bacteria, it is called an autoantibody. APS can occur in lupus or on its own. (See arc booklet 'Antiphospholipid Syndrome'.)
Conception – fertilization of the female's egg by the male's sperm and successful implantation of this fertilized egg in the womb.
Diabetes – a condition in which the body cannot process (metabolize) sugar properly. The most common form is properly called diabetes mellitus. Although it can happen in association with pregnancy, when it does it generally goes away after the baby is born.
Epidural – an injection given into the space around the spinal cord in the small of your back to anaesthetize the lower half of the body. The full name is epidural blockade.
Placenta – an organ within the womb which provides nourishment to the developing baby. The placenta is discharged after the baby is born and is sometimes known as the 'afterbirth'.
Pre-eclampsia – a common condition in the second half of pregnancy in which three things occur: high blood pressure, protein in the urine, and fluid retention. Pre-eclampsia occurs most commonly in first pregnancies.
Pre-term delivery – when the baby is born before 37 completed weeks of pregnancy.
Spina bifida – a defect in the spinal canal which can cause damage to the nerves to the legs.
Ultrasound scan – a type of scan which uses high-frequency sound waves to examine and build up images of the inside of the body. During pregnancy it is used to check on the development of the baby within the womb.
Useful addresses
The Arthritis Research Campaign (arc)
PO Box 177, Chesterfield
Derbyshire S41 7TQ
Phone: 0870 850 5000
www.arc.org.uk
As well as funding research, we produce a range of free information booklets and leaflets. Please contact the address above for a full list of titles or, on this web site, see 'Publications for People with Arthritis'.
Arthritis Care
18 Stephenson Way
London NW1 2HD
Phone: 020 7380 6500
Helpline (freephone): 0808 800 4050
www.arthritiscare.org.uk
Offers self-help support, a helpline service, and a range of leaflets on arthritis.
British Association for Sexual and Relationship Therapy
(BASRT)
PO Box 13686
London SW20 9ZH
Phone: 020 8543 2707
www.basrt.org.uk
Brook (formerly Brook Advisory Centres)
421 Highgate Studios
53–79 Highgate Road
London NW5 1TL
Phone: 020 7284 6040
Helpline (freephone for advice or to find your nearest advisory centre):
0800
018 5023
24-hour recorded information line: 020 7950 7700
www.brook.org.uk
A free confidential service specializing in sexual and contraceptive advice for young people up to the age of 25. Advice is also available online or by texting 'BROOK HELP' to 81222.
Disability, Pregnancy & Parenthood International
National Centre for Disabled Parents
Unit F9, 89–93 Fonthill Road
London N4 3JH
Phone (freephone): 0800 018 4730
www.dppi.org.uk
Offers advice and publishes information sheets including 'Parenting with Arthritis' (free to disabled to people, £5.00 to others).
Disabled Living Foundation (DLF)
380–384 Harrow Road
London W9 2HU
Phone: 020 7289 6111
Helpline: 0845 130 9177
www.dlf.org.uk
fpa (formerly the Family Planning Association)
50 Featherstone Street
London EC1Y 8QU
Phone: 020 7608 5240
Helpline (for confidential advice on contraception and sexual health):
0845 122 8600
www.fpa.org.uk
nras (National Rheumatoid Arthritis Society)
Unit B4 Westacott Business Centre
Westacott Way, Littlewick Green
Maidenhead SL6 3RT
Phone: 0845 458 3969
Helpline (freephone): 0800 298 7650
www.rheumatoid.org.uk
A national charity which focuses specifically on rheumatoid arthritis.
RADAR (Royal Association for Disability & Rehabilitation)
12 City Forum, 250 City Road
London EC1V 8AF
Phone: 020 7250 3222
www.radar.org.uk
Relate
See the telephone directory under 'Relate' or the Yellow
Pages under 'Counselling and Advice' for your local Relate centre.
Or contact Relate Central Office.
Phone: 0845 456 1310
www.relate.org.uk
Ricability
30 Angel Gate
City Road
London EC1V 2PT
Phone: 020 7427 2460
Textphone: 020 7427 2469
www.ricability.org.uk
A national charity which produces consumer guides for disabled and older people, including reports on childcare products. Contact the address above for details, or view the guides online.
Information on drugs
Separate arc leaflets are available on many of the drugs used for arthritis and related conditions. We would recommend that you read the relevant leaflets for more detailed information about your medication.
