Q&A with High-Risk Obstetrician Dr. Brian A. Mason
Brian A. Mason, MD, FACOG, is an Associate Professor at the Division of Perinatology at Wayne State University in Detroit, Michigan, and a perinatologist (high risk obstetrician) at the Division of Maternal-Fetal Medicine at St. John Hospital and Medical Center in Detroit, Michigan.
Q: Can FM affect a pregnancy? How?
A: Yes. Although there is severely limited research in this area I would like to share some related studies.
Some studies indicate reduced fertility rates among FM patients. One study found an unexplained lower fertility rate in FM patients with myofascial pain syndrome.
Source:
"Co-morbid FM accounts for reduced ability to get pregnant"
Clinical Journal of Pain, Vol. 16, pgs 29-36, March 2000
New Jersey Medical School
Another study followed how various hormone events affected FM. Twenty-six women with FM and a total of 40 pregnancies were studied. The women in the study found FM symptoms to be worse in the 3rd trimester of pregnancy (with the exception of 1 patient). In 33 of the 40 pregnancies, the women ultimately returned to the same level of FM symptoms prior to pregnancy.
There was an increase in depression, and anxiety during postpartum for the women studied. This did not affect the pregnancy or the health of the baby.
Seventy-two percentof patients had worsening FM symptoms just before menstruation. This is interesting because this mimics the changes that occur in the third trimester of pregnancy—where the majority of women studied had increased FM symptoms.
Source:
"Effect of Reproductive Events and Alterations of Sex Hormone Levels on Symptoms of Fibromyalgia"
Scandinavian Journal of Rheumatism, Vol. 26, 1997
Q: How can you control the pain of FM during pregnancy? Are certain pain relief drugs safe during pregnancy?
A: Yes, certain pain relief drugs can be used during pregnancy as well as trigger point injections.
Relatively speaking, narcotics can be used in pregnancy. The risk for birth defects, when the drugs are used appropriately, is limited. Thus narcotics are generally safe in pregnancy. More controversial are NSAIDs. If they are used at all during a pregnancy they MUST be discontinued by the end of the second trimester. Tylenol can be used—but appropriately. Don't exceed 4 grams a day (which would equal 2 extra strength pills every 6 hours per day). Aspirin is similar to the NSAIDS. A low dose may be appropriate, but it must be discontinued by late second trimester. Ultram also can be used.
Non-drug options are the best and safest pain relief solution during pregnancy. But this does not mean that patients and doctors should shy away from using medications. One weighs risks and benefits all the time. If the benefit of a medication can be life-changing, and life-improving, then I think it is reasonable to use during pregnancy.
Examples of non-drug options: meditation, aerobic activity, yoga, focused breathing, physical therapy, certain forms of massage (make sure the therapist knows FM and how to safely perform massage on a pregnant patient). Some heat therapies are appropriate—like a warm bath. The water must not exceed 100 degrees Fahrenheit, and exposure should be limited to 15-20 minutes. Note that electric heating pads and blankets are prohibited during pregnancy.
Q: Why do some women report a reduction of FM symptoms during pregnancy?
A: In pregnancy there is an increase in serotonin and cortisol, which is the body’s form of cortisone. This inhibits the body's autoimmune response and perception of pain. We often see women with chronic pain and autoimmune disorders improve during pregnancy.
Q: What advice would you have for a woman with FM who is contemplating pregnancy, but also fears FM would make pregnancy too difficult?
A: I would say that she should get the best control of FM symptoms upfront with agents that can be continued during pregnancy. Before the pregnancy is the time to test different drugs. It is a trial and error disease—there is no one best remedy, but if you find what works for you, you will have a better pregnancy.
Set hard limits for yourself. Understand pregnancy is a job in and of itself for a patient with FM. When you are pregnant, you expend much body energy just being pregnant. You can use 1200 to 1400 calories for basic life function before you even take a step, or go to work or begin chasing your kids around the house. Being pregnant is a metabolically fatiguing stage.
Limits are important, too, because it is critical that you do not push yourself past the point of fatigue. This is important for women without FM, so it is especially important for pregnant women with FM. If you plan to breastfeed you will need to consider this point too, because it actually takes more of the body's energy to produce milk than to be pregnant.
Q: What is your opinion on breastfeeding and how it relates to a patient with FM?
A: Breastfeeding is best for babies BUT a baby also needs its mother to be functional. Drugs that are used for FM may not be able to be used while breastfeeding. If you need medications to be functional you should use them and bottle-feed the infant. Formulas have come a long way. The bottom line is that breastfeeding is an individual choice, and you should not let anyone make the choice for you.
Q: How can FM affect delivery?
A: A woman with FM should be able to have a normal delivery. The important thing will be appropriate pain control. I would recommend the use of epidural analgesics.
Q: Because people with FM are more prone to clinical depression, should a woman be more concerned about knowing the signs of postpartum depression?
A: Sixty to 70 percent of all pregnant women develop the baby blues. Ten percent of women develop clinical postpartum depression. People with an underlying depressive disorder are at a higher risk for developing postpartum depression.
Yes, it is important to seek help if you believe you are experiencing postpartum depression. Indicators of postpartum include a loss of finding pleasure, consuming many carbohydrates, smoking, inappropriate tearfulness, feeling agitated or worthless.
A combination of medications and counseling have been most effective in treating postpartum depression. The good news is postpartum depression is generally short-lived. It is important to know that postpartum depression can actually begin at any time during the pregnancy, not just after the baby is born.
Q: What are the most important things you can do to ensure a healthy pregnancy for you and the baby?
A: The number one leading preventable cause of fetal complications is smoking. Avoid smoke and smoking. Eat a proper diet, get regular prenatal care, avoid toxic agents (which include certain medications), and exercise appropriately.
Q: Does a woman with FM need to work with a perinatologist rather than an obstetrician?
A: No, any obstetrician who is caring, compassionate and insightful is fine. If high risk issues emerge during the pregnancy, the obstetrician can always consult with a perinatologist.
If you are interested in more information on pregnancy and FM, or you have information on pregnancy and FM, email Sharon Waldrop at Sharon.Waldrop@mifibromyalgia.org
