Fibromyalgia, Pregnancy, and Scientific Research
My birthday turned out to be a double celebration when my friend Alison, unable to contain her excitement, blurted out that she was pregnant. After many squeals of laughter and hugs of delight we set out for lunch to celebrate.
Alison had wanted a baby since her marriage three years ago, but had been prevented from even trying for the first year while she came off all her medications for rheumatoid arthritis. Experiencing these first six months of pregnancy with her has really made me think: would I have to come off all my medications for FM before starting a family? How would pregnancy affect me? And how would I cope when the baby arrived?
My mother is quick to point out that finding a man really ought to be my primary aim, but I see no reason for not being prepared! One thing Alison and I have discovered, from glancing through countless pregnancy books, is that many of the unpleasant symptoms listed have been part of our lives on a daily basis for years. I must admit that this discovery has reduced my sympathy for pregnant women who complain of fatigue, aching limbs, forgetfulness and bowel problems; unlike me, they will completely recover in nine months!
It has also amazed us how many allowances are made for Alison now she is pregnant, compared to the lack of response and understanding towards her arthritis. Alison is quick to point out to her sympathizers that being pregnant is a doddle compared to living every day with arthritis.
Medical Opinion
So, what does medical research have to say about FM and pregnancy? Not a lot, it would seem. I have found only one study so far devoted to this subject. It was carried out in Norway in 1997 on 44 women with FM.
The study split the 44 women into two groups. Group A consisted of 26 women who had their children while suffering with fibromyalgia and Group B was composed of 18 women who had had their children before the onset of their fibromyalgia symptoms. The study was based on interviews with the women.
At first sight the news does not seem good, as the study reports:
"With the exception of one patient, all women in Group A described worsening of fibromyalgia symptoms during pregnancy with the last trimester experienced as the worst period"1
The symptoms reported by these women were generalized pain, fatigue, back pain, muscle weakness, depression, and stiffness. They also complained of aggravated symptoms 1-3 months after delivery, no doubt due to the strenuous activity of labor. Seventy-seven percent of the women in Group A admitted that they required additional support to care for the baby, and help with the housework, compared to 43 percent of the women in Group B, indicating that although women with fibromyalgia may need more assistance to care for a baby, healthy women feel overwhelmed at this time too.
The good news is that despite these complaints, all the women from Group A, except one, positively encouraged other women with FM to have children. They viewed pregnancy as a positive experience, with sixteen women recommending others to have a family of two children, and five women even advocating more than two children! Women who experienced multiple pregnancies did not describe any increase in the severity of fibromyalgia symptoms in their second or third pregnancies compared to their first. Therefore, additional pregnancies do not seem to aggravate fibromyalgia symptoms to a greater degree.
Even more encouraging is the report that women with fibromyalgia gave birth to healthy babies at full term with a good birth weight. There were no significant differences in the birth procedures or the outcome of the pregnancies between the two groups. The majority of women with fibromyalgia underwent a normal delivery with an average labor of six hours, with no increased need for a forceps delivery or a caesarean section.
Some pregnant women in Group A even chose to continue with medications during pregnancy, though these were in the minority due to fear of harming the fetus. Twelve of the women used painkillers, two used sedatives and four continued to take anti-depressants. Paracetamol (Tylenol) is believed to be the safest painkiller to use during pregnancy. It is important to check with your primary care doctor which medications you should withdraw from before conceiving, and how long it will take for these drugs to clear from your system.
Current medications can pose a problem with breast-feeding too, as they can be transferred to the baby through the milk. It is therefore important to consult your doctor before deciding whether to breast-feed or not. In this study, mothers with FM were encouraged to breast-feed if medications allowed. The majority breast-fed their babies for at least three months, some continuing for more than seven months. There were no reported increases in FM symptoms linked with breast-feeding. Of course, the advantage of bottle-feeding the baby meant that the partner could take over nighttime feeding and allow the woman to get a good night's sleep.
In conclusion, women with FM may suffer aggravated symptoms during pregnancy, but are positively encouraged by mothers with FM to go for it and not miss out on having children. Every pregnancy is individual, and fibromyalgia sufferers should be in a good position to cope with the normal unpleasant symptoms of pregnancy as they have had plenty of practice in their everyday lives! And remember—symptoms during pregnancy are transitory and offer an immense reward at the end of the nine months.
PRACTICAL HINTS
1. Plan ahead.
Be prepared for your fibromyalgia symptoms to worsen during your pregnancy and expect to need additional support when the baby arrives. Plan plenty of rest time and arrange for a relative or friend to help you care for the baby. If you work, plan an early maternity leave and expect to need extended time off following the birth.
"Mothers with fibromyalgia expressed the need for assistance with childcare and housekeeping significantly more than the controls in Group B."1
2. Consult an occupational therapist.
Ask your primary care doctor or consultant to refer you for an assessment. Occupational therapists are brilliant at coming up with solutions to all kinds of problems. They can provide you with special equipment to overcome practical difficulties, teach you how to hold and pick up the baby without straining your muscles through eccentric movements, and advise you on the best baby things to buy, i.e. baby clothes that fasten with Velcro or zips rather than snaps, lightweight strollers and height-adjustable cribs. After your initial assessment, your occupational therapist will visit you at home after the birth to help problem solve any other difficulties arising.
3. Make use of books and websites dedicated to parents with disabilities, including:
http://www.disabledparents.net/. This site provides many innovative ideas and useful contacts and resources for parents with disabilities.
http://freespace.virgin.net/disabled.parents. This is the site for Disability, Pregnancy & Parenthood International.
The Baby Challenge: A Handbook on Pregnancy for Women with Physical Disability.
MJ. Campion, published by London: Routledge, 1991
There are also excellent chapters on fibromyalgia and pregnancy in books by Mark Pellegrino and Claudia Marek.
Reference:
1 "The effect of reproductive events and alterations of sex hormone levels on the symptoms of FM", Wigers et al, Scandinavian Journal of Rheumatology, 1997, 26:355-360
