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Thyroid, Arthritis & Fibroids

If you suffer from a persistent health problem, you may be wondering if you can have a successful pregnancy -- or if the medicine used to treat your condition will harm your unborn baby. Fortunately, many conditions can be treated safely, resulting in both a healthy mom and baby.

While many women with chronic conditions have healthy pregnancies, you still need to check in with your doctor regularly about the status of your health and that of your unborn baby. Asking questions is a good way to better understand your condition and can equip you with the information you'll need to make educated treatment choices. Here, we take a look at three chronic conditions.

Thyroid Disorders

About 2 percent of pregnant women have a thyroid disorder. Some develop the condition before pregnancy, while others experience thyroid problems for the first time during pregnancy or soon after delivery.

Shaped like a butterfly, the thyroid gland is located in your neck; it produces hormones that regulate your metabolism and control many of your body's organs. Problems arise when the immune system mistakenly attacks and destroys cells in the thyroid gland (creating an autoimmune disorder), which results in the thyroid's producing too much hormone (a condition known as hyperthyroidism), or too little (hypothyroidism).

Because untreated thyroid disorders can be harmful to both mother and baby, all conditions require prompt treatment in pregnancy. Babies of women with untreated hypothyroidism can have a higher risk of being born with neurological or developmental problems, including mental retardation. Women with this condition are often treated with hormone replacement pills.

Those with untreated hyperthyroidism also have an increased risk of complications, including a pregnancy-related form of high blood pressure called preeclampsia. If you have this condition, you'll be treated with medications that reduce your body's amount of thyroid hormone. Pregnant women with this illness should not be treated with radioactive iodine (a common treatment). This drug can damage your baby's thyroid gland, resulting in hypothyroidism.

The good news is that most medications used to treat thyroid disorders are considered safe in pregnancy. If you take medication for your condition, your healthcare provider will regularly measure the amount of thyroid hormone in your blood and make adjustments as the pregnancy progresses.

 

Though most healthcare providers don't routinely screen pregnant women for thyroid disorders, your doctor may recommend testing if you have a family history or another autoimmune disorder (such as diabetes), or if you experience any symptoms. Most conditions can be easily diagnosed with a simple blood test and can be treated safely, enabling you to have a healthy baby.

Each year rheumatoid arthritis affects 1 in 1,000 pregnant women. Telltale signs include painful, red, swollen joints (fingers are often the first to be affected), accompanied by a feeling of stiffness and fatigue, particularly in the morning. Rheumatoid arthritis is an autoimmune disease, in which the immune system mistakenly attacks the body's joints. If you have this condition, you're just as likely as unaffected women to have a healthy baby. In fact, another nugget of good news is that during pregnancy, your symptoms may get better, or even disappear. Seventy-five percent of affected women experience relief during pregnancy, though doctors don't know why. Less pain may mean less medication -- which is good for you and baby. But it's still important to consult your doctor to discuss treatment options.

While there are a number of arthritis medications that are safe to take during pregnancy, there are some that can be dangerous. You may not need to take any pain medication during pregnancy, but if you choose to, your doctor may recommend acetaminophen (such as Tylenol), which is considered safe for you and your baby. Nonsteroidal anti-inflammatory medications (ibuprofen, naproxen, and others) may also be recommended early in pregnancy, but not later because they can increase the risk of a heart problem in your unborn baby. If you fail to find relief with these options, your doctor may suggest prednisone, a steroid medication. Certain cancer medications (such as methotrexate) and antimalarial drugs that can be used to treat rheumatoid arthritis may also increase your risk of miscarriage and birth defects.

Rheumatoid arthritis shouldn't affect your labor and delivery. But it's still important to discuss any joint limitations you may have with your healthcare provider so she can help you find comfortable labor positions.

A few months after baby's birth, old symptoms are likely to flare up and you may need to resume your medication. If you choose to breastfeed, remember to discuss with your pediatrician which options are safest for baby.

Commonly consisting of muscle and fibrous tissue, fibroids are growths that can develop on the wall or outside of the uterus. Although fibroids are sometimes called tumors, they're usually benign (noncancerous). Often developing prior to pregnancy, fibroids can vary in size. Many women don't know they have fibroids until they have a pelvic exam.

Most women with fibroids don't experience pregnancy complications. But common symptoms can include abdominal pain accompanied by vaginal bleeding and a low-grade fever. While it's uncommon for flare-ups to harm your unborn baby, you should speak to your doctor if you have any symptoms. Your healthcare provider may recommend bed rest, ice packs, or medication. With treatment, symptoms generally subside in a few days. Fluctuating pregnancy hormones can cause fibroids to grow larger. If this occurs, your doctor may recommend an ultrasound to see if your growths are likely to cause complications. Enlarged fibroids often shrink after delivery.

Unfortunately, having this condition can put you at a slightly higher risk of miscarriage or premature delivery, especially if your growths are large. If the placenta implants itself over a large fibroid, you can have an increased risk of placental abruption (when the placenta separates partially or completely from the uterine wall prior to delivery). Fibroids can also block the cervical opening, increasing the likelihood of cesarean delivery.

If you have growths, ask your doctor whether their size or position could pose problems, and which signs to watch for.

Many pregnant women have questions about how their health will affect their baby. Even if your most serious problem is a common cold, never hesitate to discuss your concerns with your doctor so that you can work together to ensure a healthy pregnancy.

 

Richard H. Schwarz, MD, obstetrical consultant to the March of Dimes, is past president of the American College of Obstetricians and Gynecologists; vice chairman for clinical services, Maimonides Medical Center; and professor of obstetrics and gynecology, SUNY Downstate Medical Center, both in Brooklyn.

Originally published in American Baby magazine, February 2004.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your won health or the health of others.