Empowering women with Rheumatoid Arthritis (RA) to make pregnancy decisions

Becoming a mother can be a daunting prospect in the best of circumstances, but contemplating motherhood as an RA sufferer brings its own set of problems, with a multitude of issues to consider.

Of particular concern is the need for accurate information on medication safety. Some RA treatments are known to cause birth defects, whilst others could potentially interfere with labour, affect amniotic fluid production, or cause excessive bleeding during delivery. The impact on breastfeeding also needs to be considered. While in some cases symptoms can be milder during the course of the pregnancy, they can often return with a vengeance postpartum, for a while at least.

Arthritis New South Wales identified a considerable gap in the provision of information to help support women with RA contemplating motherhood. As a result, they led the development of a decision aid (DA) to help women with RA make informed choices about whether to start a family, or have more children.

The DA was designed in the form of a 45-page booklet entitled “Motherhood Choices | A decision aid for women with Rheumatoid Arthritis”,which, according to the introduction, provides balanced information about the risks and benefits of different options before, during and after pregnancy.

“It is a starting point for information that women with RA need to know about RA, medicines, pregnancy, breastfeeding and motherhood,” according to Arthritis NSW.

A randomised controlled study of 144 women was conducted to evaluate the effectiveness of the DA. The researchers found that women using the resource had a 13% increase in relevant knowledge scores and a 15% decrease in scores for decisional conflict compared to the control group.. Levels of depression and anxiety symptoms remained unchanged, however, suggesting there were no adverse psychological effects from using the aid.

Two key points are central to the DA:

  • The need to plan and consult with health professionals when contemplating pregnancy and
  • Decisions need not only be whether to have or not have children, but to possibly postpone decision until one feels healthier, options are clearer or timing is better.

“This initial evaluation suggests that it is effective in improving relevant knowledge and reducing decisional conflict without influencing women’s decisions or causing distress,” commented the authors.

A small number of shortcomings have been identified, such as the need to further refine the content in the aid in relation to the risks and benefits of individual RA medications.

Nonetheless, the brochure is a significant step towards empowering women with chronic diseases to make important decisions regarding their use of medication when planning a pregnancy


The study was published in BMC Musculoskeletal Disorders on 22 September 2015


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