Fibromyalgia is the disease of a million myths, because of
all the misunderstandings, half-truths and untruths that exist about it. One of
these myths is that it is strictly a middle-aged to older woman’s disease.
However, besides the fact that children and men get it too, more than half of
women with fibromyalgia are under age 40, still in their reproductive years. This
begs the question: what happens in women with fibromyalgia during pregnancy?
More specifically, what happens to them, what happens to their baby, and how
does pregnancy affect the treatment and course of their fibro?
Well first, let me give you the exciting results of my latest poll in which I asked the question: If you have been pregnant since your fibro started, what happened to your overall level of pain during pregnancy?
Drum roll please...
As you can see, a grand total of TWO people answered the question. One woman said her pain improved a lot, while the other said it got a little worse. Not much help. So let me tell you what I've learned about fibro and pregnancy through my past practice as a doctor/fibro expert and my reading of the scientific literature...
How does pregnancy
affect fibromyalgia symptoms? To begin with, not every pregnant woman’s
experience with fibro will be the same. However, they typically experience an
increase in pain, especially over the last few months of pregnancy. This is
when even healthy women tend to experience more discomfort, because they are
gaining weight rapidly, the baby’s growth is accelerating, and there is
increased pressure on their low back, an often problematic area in
fibromyalgia. On the other hand, during pregnancy, chemicals like relaxin are
released in the body that, among other things, help to relax muscles, which may
have some beneficial effect. All in all, however, the average woman with fibro
will notice a significant increase in her pain especially over the last few
months, particularly in the low back and hip area.
How does fibromyalgia
affect pregnancy? This question has two parts. First, how does fibromyalgia
affect the likelihood of pregnancy? Though there has been little research in
this area, there is no evidence that fibro negatively affects how fertile a
woman is. However, many women (and men) with fibro experience discomfort during
sexual activities, which may cause them to engage in them less frequently. Once pregnancy is achieved, fibromyalgia can
affect the pregnancy itself. For example, in one study conducted in Israel, 112
pregnant women with fibro were more likely to have smaller babies, recurrent
miscarriages (roughly 10% of the women), abnormal blood sugars, and excessive
amniotic fluid; but they also were less likely to have a baby born prematurely,
and were no more likely to require a C-section or any special procedures.
Are fibromyalgia
treatments/medications dangerous for pregnancy? VERY few medications are
given a nod during pregnancy, regardless of what they are for or the condition
being treated. In fact, some drugs are purposefully not even tested in pregnant
women, because of the potential for lawsuits. As such, there is little research
to go on. Traditional wisdom, which most doctors follow, is to discontinue as
many medications as possible while a patient is pregnant, and this certainly is
true for fibromyalgia. Does this mean that a woman must stop ALL her fibro
medication? Not necessarily. What it does mean is that she, her partner and her
doctor MUST sit down and discuss the various benefits and risks of either
stopping or continuing each medication she’s on.
What is the best way
to treat fibromyalgia while pregnant? Fortunately, medications are not the
only treatments proven effective for FM. Stretching, meditation, yoga, and deep
heat ointments may help. Pool therapy and/or sitting in a hot tub may be
particularly soothing, especially for those with back pain, and especially late
in the pregnancy. Massage may be helpful too, as long as it is not overly
aggressive. Exercise is important as well, but must be tailored to the person’s
ability and endurance; once again, being in a pool may help. And rest is
crucial. Even healthy pregnant women often find the need to sit or lie down to
relieve pressure on their back and legs. Scheduling regular 20-30 minute breaks
throughout the day can be very helpful. This may require that women in the
workforce need to take a leave earlier than they intended; and they should
be supported by all parties (family, doctor(s), and employer) in this health-related
decision.
Does fibromyalgia have
any effects on delivery? Although it might be expected that women with FM
will have more pain during labor and delivery than women without, there is no
evidence that outcomes are significantly different. This makes sense, given that
spinal blocks that can now be given to effectively relieve the pain over the
last few crucial hours. As stated earlier, fibromyalgia does not appear to result
in premature deliveries or more C-sections, suggesting that women with fibro
ultimately tolerate labor as well as other women.
What happens after the
baby is born? It is widely believed that a woman’s fibromyalgia will
continue to be worse than pre-pregnancy levels, and that has been my experience
in the past with most, but not all women. Fibro sufferers typically have very
disrupted sleep; and research has shown that the worse their sleep is, the more
pain they have, especially in the morning. It’s no coincidence that the
mother’s fibro generally doesn’t start returning to baseline until after the
baby starts sleeping a bit better. It is crucial also that the woman’s mood is
followed closely, since post-partum depression can be missed or misinterpreted
as “just your fibro”.
What is important to
consider when planning a pregnancy? First of all, once a woman has decided
that pregnancy is something both she and her partner want, she needs to make
sure she has the proper support in place. Having a doctor who listens to her, a
therapist she can turn to, a warm pool she can use, a supportive partner, and additional
friends and family members who can help too, all is crucial. Some of this
support may come from her local fibromyalgia support group, where she may find
women who’ve already gone through all this. Second, although breastfeeding is
desirable for the child, if she needs to go back on medications to manage fibro
symptoms getting out of control, she may need to choose to bottle feed the baby
sooner than initially planned.
Does fibromyalgia
affect postnatal mother’s health and postnatal care? Long term, there is no
evidence that going through a pregnancy will make a woman’s fibro worse beyond
the first 6 or so months after delivery. By then, she should have been able to
resume any medications that had been controlling her symptoms, and both she and
the baby are sleeping better. She will continue to require the support of her
partner, other family and friends, as all mothers do.
If you have enjoyed reading this, please check out award-winning
best-selling book on fibromyalgia at Amazon. It has been called a MUST-READ for anyone interested in this sadly misunderstood disease.
Kevin P White, MD, PhD
