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Date: 11.02.2011
From: x kerry x

Subject: pregnancy and sulfasalazine

hey, just looking for a bit of reassurance...found out last week that im 6 weeks pregnant, which takes me back to approximately the same date i started sulfasalazine. I was on it for 2 weeks and had a bad reaction to it and ended up in hospital. I cant get an apt with anyone from my rhumy team for a few weeks and im desperate to know if taking this in the very early stages of pregnancy could have have harmed my baby in any way? I was also taking ibuprofen and gabapentin, both of which you are not meant to take during pregnancy. Its a good job i decided to do a pregnancy test before i started mtx, just incase. Also, is it hard having a new born baby and arthritis? I know it can go into remission (which hasnt happened for me yet) but looking after myself is so hard on bad days, im worried how im going to cope with a baby too. I was just getting my head round having arthritis, and now im pregnant with arthritis! Scary times..... Thanks for any advice in advance x
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Date: 12.02.2011
From: davina

Subject: Re: pregnancy and sulfasalazine

Hi congratulations first of all. sorry i can't help you with the info for sulfasalazine cause i have just started but i have a 20 month old and my ra started when he was 5 months. it can get hard especially if you get a baby who is difficult at night as i did. (and still not sleeping through)! my main problem was in the middle of night and early morning nappie and making a bottle. i use to have the night and morning bottle made and ready and stopped using vests for bed so i didn't need to do the poppers.

i think it will be hard but you will ajust to it. sorry if you don't like what i'm saying but i think you should know the truth.
good luck and keep us posted. t/c

p.s let me know about the meds and pregnancy cause i want another baby soon. you could try and ask your rheumy or nurse to call you.
davina. x
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Date: 12.02.2011
From: Lucy

Subject: Re: pregnancy and sulfasalazine

Hi Kerry, Congratulations on your pregnancy! A bit of a shock I'm sure. During your first trimester it is recommended that you do not take any medications at all, but as over half of pregnancies are unplanned this doesnt always happen - just like the drinking and smoking etc! As a midwife I'd recommend you speak to rheumy straight away and if not your GP as you may need to have your medication changed, reduced.
Some research I have read since reading you blog says there is no increased risk in congenital defects or newborn toxicity in studies undertaken. As with any pregnancy in a arthritic patient or person with no problems, there are no guarantees. Chances are they will refer you to a consultant at the hospital and you may be offered more scans during the pregnancy.
Make sure you're taking your folic acid, get an appointment with your GP immediately and stalk rheumy for a phone consultation or appointment next week.
Dont dwell on the medications you have taken for your disability, there are things you can take during pregnancy and you should be well supported by your midwife and consultant. Am about if you need any advice.
Congratulations and enjoy - saves you from the MTX and hopefully you'll go into remission for the pregnancy and post natal period xx
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Date: 12.02.2011
From: x kerry x

Subject: Re: pregnancy and sulfasalazine

thats really helpful, thanks! No davina im not offended at all, i much prefer to hear the truth about these things. The advice you gave about bottles and vests is just what i need, people keep saying 'you'll just cope, you have to' but nobody is telling me how to cope. I might have a look to see if there are any websites with helpful tips like that.

Lucy, thank you for sharing your knowledge, i have got an apt with my doctor on wed so i will speak to him about it and will 'stalk' my rhummy, lol, to try and get some advice off them. I was in hospital at the beginning of this week with dehydration and they had said i would be refered to a special unit for pregnant women with diseases but i havnt heard anything about when it may be. Ive had one scan already, and have another a week on wednesday and everything seemed fine but when i asked them at the anti natal unit about the sulfasalazine they didnt know much about it. Thanks again guys, and any other tips you can give me would be much appreciated xx
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Date: 12.02.2011
From: sandra lowe

Subject: Re: pregnancy and sulfasalazine

hi kerry congratulation xx dont know much about meds and pregnancy was off them. i had 3 children the arthritis did go into intermission.and as for caring for baby you find ways to handle situations as they acure. Let us know how you get on xxxx
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Date: 12.02.2011
From: x kerry x

Subject: Re: pregnancy and sulfasalazine

thanks sandra! I was just getting my head round having arthritis...now ive gotta get used to being a mummy with arthritis, im sure it'll all be worth the hard work xx
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Date: 12.02.2011
From: cookie

Subject: Re: pregnancy and sulfasalazine

Hi hon great news! I was on sulphersalazine when i got preggie with both my babies they are both healthy and well. Your gp will deal with your day to day care as the rheumy team dont have the capacity my gp stopped all my meds although he said i could stay on them but he wouldnt reccomend it. I was fine all the way through apart from the puking lol. My gp gave me higher doses of folic acid as sulph can knock that down significantly instead of the 0.5 mgs i took 5 mgs. Its bloody hard work when they arrive but oh so worth it. My ra kicked in again 3 months after delivery but i know of at least 2 women locally who have been in complete remission since giving birth. Take all the help you can when the babys born even if its for a snooze during the day xxx
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Date: 12.02.2011
From: x kerry x

Subject: Re: pregnancy and sulfasalazine

yay! That is good news...i was just worried because people keep asking me 'what about the drugs you've been on?' and i couldnt answer, or find anyone who could! Ive just been taking the folic acid that was prescribed to me with the mtx which are 5mg, but i was only given 4 of them so will have to get more on wed. Im lucky to have a good support network of family and friends and of course my fiancee who all kind of understand my situation and have all offered lots of help when baby arrives. Can i ask cookie, did you manage to give birth naturally? My rhummy had said once before i was pregnant but was discussing the future and pregnancy that i would probably have to have a c section as my pelvis and hips may struggle with giving birth....xx
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Date: 12.02.2011
From: cookie

Subject: Re: pregnancy and sulfasalazine

Hi kerry. I did give birth naturally for both my girls but to be honest i have never really had problems with my hips. If i could give you one bit of advice it would be to avoid an epidural (a long way off i know lol ) the only reasoni say this is i had such a terrible back for 2 years after my first when i had an epidural and was fine after my second when i didnt. After you have delivered you produce a hormone called somthing like relaxin. For about 2 years this relaxes muscles ligaments etc obviously when you have ra this can pose big problems. Try to stick to gas and air. Tens and pethadine if you can.most importantly enjoy your preganacy. Its fab being a mummy xxx let me know if there is anyghing else xx
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Date: 12.02.2011
From: x kerry x

Subject: Re: pregnancy and sulfasalazine

thanks cookie! Its such a relief having people to ask who have already been through these things xx
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Date: 13.02.2011
From: Lucy

Subject: Re: pregnancy and sulfasalazine

Kerry, us arthritics really benefit from water at any time but this can be fab whilst in labour. You have a long way to go yet but can give you info as and when you need x
Good news you're seeing your GP and getting things sorted, you will be classed as "high risk" in your pregnancy but this doesnt mean you cant have a normal delivery and normal healthy baby.
As with your condition now, you will find ways around any problems you may encounter when you have the baby. Us lot are tough cookies!
Keep up your fluid intake and take it easy, you may find yourself even more tired than usual. Good luck honey xx
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Date: 13.02.2011
From: KayJay

Subject: Re: pregnancy and sulfasalazine

cookie I had exactly the same problem with my 2nd epidural however it was a traniee that tried to do it so it was very traumatic and the start of my lower back pain. My 3rd baby I had with just gas and air and painkiller [ think it was Heroin but the medicinal kind !! ] they didn't offer tens way back then [ 80's ]and he was born on the exact day they gave me.

HOWEVER Kerry - giving birth is a totally unique and wonderful experience all you can do is to ask and discuss with your medics and remember - one person's experience can be totally different to another.

If you do opt for an epidural just make sure the midwife knows well in advance as they have to do blood tests first [ and analized ] and make sure it is given to you by an experienced anaethatist. It is pain free so it's all good ;0)
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Date: 14.02.2011
From: cookie

Subject: Re: pregnancy and sulfasalazine

As you say pregnancy is individual i was classed as low risk for both my pregnancies i think it depends on local policy and other risk factor you may have x
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Date: 14.02.2011
From: louloubelle

Subject: Re: pregnancy and sulfasalazine

Hi Kerry

CONGRATULATIONS!!!

I had my first baby in September. I have PA and had been taking anti-tnf with amazing results. I told my rheumy I was going to be trying for a baby and he kept me on anti-tnf and prescribed sulfazalazine so that I could stop the anti-tnf as soon as I fell pregnant and the sulfa would already be in my system; it is considered to be quite safe to use during pregnancy. However, sulfa was useless for me and I found the beginning of the pregnancy super difficult but the arther improved as the pregnancy went on. As the sulfa wasn't working my rheumy took me off them and gave me regular steroid injections, although you have to be careful later on in pregnancy because of the effect it has on baby's lungs (they can over develop) .

With regards to using other medicines, I was unfortunate enough to require two rounds of chemo for breast cancer at the end of the pregnancy and my gorgeous baby Oscar was not affected in the slightest - the placenta does the most incredible job!

Because of chemo I am not on any meds at the mo and my son is 5 months old. I am finding it really tough but am relying on family and my partner to help out a lot. Take help when yuo need it; it also means that baby is used to lots of people and I think by doing this, Oscar is really chilled out and not at all clingy! Although I do make sure we have lots of cuddles so he deffo knows who is mummy is.

I am looking forward to next week when I can have some arther meds and hopefully begin to be a proper mum.

I hope it all goes well. If you want to ask anything then please don't hesitate.

All the best
Lou x
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Date: 18.02.2011
From: x kerry x

Subject: Re: pregnancy and sulfasalazine

thanks alot for all the advice ladies! Still havnt managed to see my rhummy but seen my doctor yesterday and he confirmed that sulfa is relatively safe to take during pregnancy. My arthritis has been really bad today however, but im just trying to ease the pain with heat instead of medication, i think my poor baba's had enough of them already in its short life! Got another scan on wed to double check all is well, ill let you all know how it goes. Thanks again girls, and lou...i wish you all the best with your treatment, i beleive babies are a blessing in any case, but theyre a really special blessing when you have an illness too xx
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