Lupus, Rheumatoid Arthritis Affect Birth Rates

Women With the Autoimmune Diseases Often Have Fewer Children Than Desired, Study Finds

By Salynn Boyles
WebMD Health News

Reviewed by Louise Chang, MD

Feb. 16, 2012 -- More than half of women diagnosed with lupus or rheumatoid arthritis prior to completing their families end up having fewer children than they had planned for, new research suggests.

The study is among the first to examine infertility, pregnancy loss, and family planning choices in women with the autoimmune diseases.

Lupus, RA, and Childbirth

Rheumatoid arthritis (RA) and lupus are often diagnosed in younger women, yet their impact on childbearing is not well understood.

It is clear from earlier research that women with rheumatoid arthritis tend to have fewer children than healthy women and that women with lupus have more miscarriages.

But the reasons for this are not so clear, and prior studies have not examined how living with a chronic autoimmune disease impacts family size and family planning decisions, says Duke University Medical Center investigator Megan Clowse, MD, who runs the center's autoimmune disease pregnancy registry.

"We wanted to learn more about how having lupus or rheumatoid arthritis influenced these decisions," she says.

Clowse and colleagues surveyed 578 women with rheumatoid arthritis and 114 with lupus enrolled in a national autoimmune disease registry.

Among their findings:

  • 55% of the women with rheumatoid arthritis and 64% of those with lupus who were interested in having children reported having fewer children than they had hoped to have.
  • Rheumatoid arthritis patients who had fewer children than planned were one-and-a-half times more likely to report problems with infertility than patients who had as many children as they had hoped for.
  • Lupus patients who had fewer children than they had planned to have had a three-fold higher miscarriage rate than lupus patients who had the number they had planned for. There was no significant difference in infertility rates.

RA Patients Had More Infertility

Overall, 42% of the rheumatoid arthritis patients who had fewer children than desired reported having problems conceiving.

The finding came as a surprise to the investigators.

"This study highlights the need to understand why women with rheumatoid arthritis appear to have more problems with infertility," Clowse says. "This has not been studied at all."

She adds that women with rheumatoid arthritis who wish to have children need to know that their ability to conceive may be compromised.

"This needs to be part of the conversation," she says. "Women with rheumatoid arthritis who want to have children may be better off trying to conceive sooner rather than later if their family circumstances support this."

Infertility did not fully explain why so many women with rheumatoid arthritis had fewer children than they had originally planned to have.

Among fertile patients who fell into this category:

  • Fifty-three percent reported concerns that their illness would negatively impact their ability to care for children.
  • Thirty-seven percent expressed concern that their disease or medication would negatively impact a pregnancy.
  • Seventeen percent were concerned that their children would develop the disease.

Pregnancies Should Be Planned

New York rheumatologist Cynthia Aranow, MD, says young women with rheumatoid arthritis or lupus who are considering having children need to plan their pregnancies carefully.

Aranow is an investigator with the Feinstein Institute for Medical Research in Manhasset, New York.

Women with lupus, for example, can reduce their risk of having a miscarriage or a baby born prematurely by avoiding conception until their disease has been inactive for at least six months, Aranow tells WebMD.

And certain rheumatoid arthritis medications, such as the widely prescribed drug methotrexate, are not safe for use during pregnancy.

"There are relatively safe medications for both of these conditions that can be used during pregnancy," Aranow says. "That is why pregnancy planning is crucial."

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SOURCES: Clowse, M.E.B. Arthritis Care & Research, Feb. 16, 2012.Megan E.B. Clowse, MD, MPH, assistant professor of medicine, division of rheumatology, Duke University Medical Center, Durham, N.C.; director, Duke Autoimmunity in Pregnancy Registry.Cynthia Aranow, MD, investigator, Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, N.Y .News release, Wiley-Blackwell.

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