A.S. and Pregnancy – The 1st Trimester

Baby boy is coming in June!

I feel like most people with chronic illnesses are super in tune with their bodies. We know when something is off.

That was definitely the case when it came to finding out I was pregnant with baby number 2.

I just knew. My body felt it. My husband said there was no way I could tell that early, but sure enough at about 9 days post-ovulation (5 days before my missed period) I got a positive pregnancy test.

Going into a second pregnancy I tried to keep an open mind. Maybe my experience this time would be better.

My rheumatologist told me that 60% of women with A.S. go into remission during pregnancy- but unfortunately with my first I was a part of the minority, and experienced a major second trimester flare (read more about that experience here!).

That flare was HARD. Not just physically, but mentally. I felt stuck- like there was nothing I could do to help my symptoms, and that I was just doomed to ride out the rest of my pregnancy barely able to walk or sleep. This time, at least I had a plan in place so that if I did flare I knew what options I had, and knowing that it wouldn’t last forever made me feel a little better.

With both pregnancies I made the decision (of course consulting with my rheumatologist) to come off of my biologic medication. I was taking Humira when I got pregnant with Davie, and stoped my injections as soon as I got a positive pregnancy test.

With this baby, I have switched to Enbrel, and waited until week 10 of pregnancy to stop injections. I’m not sure I’ve ever talked much about what led me to the decision to stop medications, but it was all based on studies that my rheumatologist discussed with me at appointments well before I even considered having kids (one study linked here).

TL;DR: There truly hasn’t been enough research done to make any definitive claims- but there have been studies done that show a link between anti-TNF-Ξ± drugs and complications including intrauterine growth restriction (IUGR). In other words, patients taking these biologics (like Humira and Enbrel) showed an increase in delayed fetal growth/under-developed organs.

To be honest, when my husband and I first started talking about having kids I was terrified of passing A.S. to them- to the point of considering not having children at all. Obviously we decided to have them (maybe a conversation for another time), but I was still afraid of letting any aspect of my illness impact my baby- including the medication I was taking to manage it.

Knowing that TNF inhibitors can’t cross the placenta until the second trimester, I was comfortable staying on my medication for most of the first trimester, factoring in time for it to leave my system before the second trimester started.

Organ development is completed by the end of the second trimester, and since the major concern with staying on medication was underdevelopment, I do plan on going back on Enbrel once I reach the third trimester (ultimately this is what I ended up doing in my first pregnancy as well).

That being said- I know there are tons and tons of women who stay on medications throughout their pregnancy and have perfectly healthy babies- this is just the logic behind my personal decision to stop.

Being on medication kept my A.S. completely in check for my first trimester, but this time around the nausea was much worse than with my first (maybe because its a boy?).

I also definitely took for granted that when I was pregnant with Davie I could pretty much nap whenever I wanted, and now I don’t have that option- so the fatigue has hit SO MUCH harder.

I’m anticipating a second trimester flare like I had during my first pregnancy, but having a plan and knowing what to expect makes me a little less anxious about it this time around.

I’ll update again at the end of Week 27!

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