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How Does Ankylosing Spondylitis Affect Pregnancy?

Ankylosing spondylitis symptoms may be exaggerated by pregnancy. Learn more about what to expect and how to minimize pain. Ankylosing spondylitis (AS) is a type of rheumatic inflammatory disease that leads to spinal bone fusion. When the bones in the spine fuse together, they become rigid and less flexible, leading to posture issues like hunching. Symptoms such as pain

  • Posted on 23rd May, 2022 22:35 PM
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How Does Ankylosing Spondylitis Affect Pregnancy? Image

Ankylosing spondylitis (AS) is a type of rheumatic inflammatory disease that leads to spinal bone fusion. When the bones in the spine fuse together, they become rigid and less flexible, leading to posture issues like hunching. Symptoms such as pain and stiffness in the lower back can develop in people with the disease.

While having AS doesn’t affect a person’s ability to become pregnant, it can lead to issues during pregnancy, such as premature birth. Pregnant people may also experience symptom flare-ups over the course of their pregnancy.

This article discusses how AS affects pregnancy and how to treat symptoms while pregnant.

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Does Ankylosing Spondylitis Affect Pregnancy?

Having ankylosing spondylitis during pregnancy can affect a person’s level of comfort as well as delivery. The most notable issues caused by AS during pregnancy occur during delivery. There are three major risks associated with pregnancy and ankylosing spondylitis, which include:

  • Difficulty giving birth vaginally, resulting in an increased risk of cesarean section (C-section, delivering the baby through surgical incisions in the abdomen and uterus)
  • Issues with administering anesthetic, namely an epidural (procedure in which anesthetic is injected into the area around the spinal cord in the lower back), during delivery
  • Limited neck movement because AS makes it difficult for people to use breathing tubes if necessary for general anesthesia during delivery

It should be noted that though these risks are possible, they are rare in people with AS.

Research has suggested that the increased risks of adverse effects in pregnancy could be driven by the medication that people take to control ankylosing spondylitis.

Does Pregnancy Make AS Symptoms Worse?

Some studies suggest that pregnancy has been shown to exacerbate symptoms in people with AS. When people do experience an increase in symptoms, it most commonly occurs during the second trimester. However, other studies have found no correlation between worsened AS symptoms and pregnancy. More research is needed to determine whether pregnancy truly is the cause of heightened symptoms.

Does Ankylosing Spondylitis Affect Fertility?

Research surrounding fertility and AS is generally mixed, so it's difficult to determine whether fertility is affected by it.

Some studies find that fertility can be negatively affected in both men and women. However, women seem to be more likely to be affected than men. Most studies have found that fertility in men is not affected by ankylosing spondylitis.

For women, research has examined how the disease affects ovarian reserves, a term that describes the ovaries' ability to provide eggs that are viable and healthy enough to lead to full-term pregnancy. One study found that ankylosing spondylitis can lead to less viable eggs from the ovary in some people who wish to become pregnant after the onset of the disease.

Conflicting Evidence and Fertility

The conflicting evidence surrounding fertility and ankylosing spondylitis may stem from the fertility issues seen in other rheumatic diseases. In cases of other diseases, such as systemic lupus, sperm viability is negatively affected, which may have led to the belief that the same could be true for all types of arthritis, including AS.

Treating Ankylosing Spondylitis During Pregnancy

Typically, treatment for ankylosing spondylitis consists of a combination of exercise, physiotherapy, and medications.

Medications that treat AS include:

  • Pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen and naproxen), Tylenol (acetaminophen), and codeine
  • Anti-TNF drugs, which are medications designed to hinder the release of a chemical known as tumor necrosis factor (TNF) that is produced in excess when there is inflammation within the body
  • Monoclonal antibodies, which block certain proteins that cause inflammation
  • Corticosteroids that reduce inflammation

These medications are not all approved during pregnancy or for the entirety of the pregnancy. For example:

  • NSAIDs should not be taken after 20 weeks.
  • Anti-TNF drugs are considered safe during pregnancy but can cross over the placenta after the second trimester starts. Some people may not want to expose their baby to them during pregnancy. Cimzia (certolizumab) is considered a safer anti-TNF drug during pregnancy.
  • Monoclonal antibody treatments may increase the risk of infection or improper immune response in newborns.
  • Corticosteroids are generally considered safe but can also increase the risk of adverse effects, such as cleft lip (when the baby's upper lip doesn't form properly during pregnancy). 

If you have AS and are taking medications to manage it, you should speak to your healthcare provider about what you can and cannot continue taking throughout the course of your pregnancy, as well as the risks involved in certain medication use.

Pregnancy and Exercise

If you are pregnant, avoid strenuous exercise. A good rule of thumb is to exercise only to the point that you can still hold a conversation. You should also avoid any exercises that may increase the risk of a fall, such as cycling or gymnastics. Any exercise that involves lying on your back for long periods of time or involves contact with others in the form of being hit should also be avoided.

Risks of Ankylosing Spondylitis During Pregnancy

There are limited risks associated with ankylosing spondylitis during pregnancy.

However, research has found that a person with AS who becomes pregnant may be at an increased risk of needing a C-section. They may also have a harder time receiving an epidural or general anesthesia because of the way the condition affects both the spine and the neck.

Previous research has made claims that it could lead to an increased risk of low birth weight and preeclampsia (a dangerous pregnancy complication causing very high blood pressure, swelling, and protein in the urine). However, that research has since been refuted.

When to See a Healthcare Provider

If you have AS and become pregnant, you should visit your healthcare provider. They will be able to go over treatment options with you so you can continue to monitor and manage your disease during the course of your pregnancy. They can also answer any questions you may have about risks associated with the disease and being pregnant.

If you are pregnant and are experiencing pain from AS, you should visit your healthcare provider to ensure that there are no issues with the pregnancy and to develop a possible treatment plan to manage the disease.

When to Call 911

If you experience any severe pain in your belly or abdomen, are bleeding, or experience worsened symptoms that feel excruciating, call 911 or go to the emergency room.

Summary

Ankylosing spondylitis is a rheumatic disease that develops when the bones in the spine begin to fuse together. The disease itself causes symptoms such as lower back pain and joint pain and stiffness. While getting pregnant with AS may be only minimally more difficult, the condition doesn’t generally affect fertility.

Having AS doesn’t typically affect the health of the fetus or the pregnancy, either. However, it can cause issues with delivery because it can increase the risk of needing a C-section and cause difficulties when trying to administer a local or general anesthetic.

Immediately after you learn you’re pregnant, have a discussion with your healthcare provider about how you should treat your AS. This way you can avoid taking medications for AS that are dangerous during pregnancy.

A Word From Verywell 

Having ankylosing spondylitis during pregnancy can be difficult to cope with, especially if you experience a flare-up of symptoms. Fortunately, having the disease is unlikely to affect your ability to conceive or have a healthy pregnancy. Work closely with your healthcare team to manage the disease while pregnant and do everything you can to ensure a healthy pregnancy and delivery.

Frequently Asked Questions

  • Can you get an epidural with ankylosing spondylitis?

    While you can get an epidural with ankylosing spondylitis, performing one may be more difficult because of the way AS causes fusion of the spinal bones. Getting an epidural done properly is difficult for those with the condition since it requires a needle to be placed near the spine. It is one of the most notable negative effects the disease has on pregnancy. However, getting an epidural is still possible.

  • Can childbirth trigger ankylosing spondylitis?

    The cause of ankylosing spondylitis is not yet known. What is known is that it's not something that can be triggered by pregnancy. It is thought that genetic factors are the most likely cause of the disease.

  • Can I pass ankylosing spondylitis to my kids?

    Unfortunately, ankylosing spondylitis can be passed down through generations. This is because there is a genetic component that researchers believe plays a role in its onset. The gene associated with the disease, HLA-B27, can be passed to your children, and if you have the gene, there is a 50/50 chance that your child will have the gene as well.

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