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Having been a part of the chronic illness community since my fibromyalgia diagnosis and now working in fertility and pregnancy, planning for pregnancy with chronic illness is a particular passion of mine.
Almost half (49.0%) of Australian females have one or more chronic conditions, and one in five (20.7%) have two or more. Autoimmune diseases disproportionally affect women and are relatively common among women who are planning to become or are pregnant. Fortunately, with medical progress and detailed pregnancy planning in collaboration with a healthcare team, it is rarely necessary to advise against pregnancy. So how does chronic illness affect fertility, pregnancy and postpartum?
The impact of autoimmune disease and chronic illness on fertility is highly debated. In some cases, fertility isn’t impacted by autoimmune diseases. However, some untreated chronic illnesses such as hypothyroidism, hyperthyroidism and celiac disease are known to cause a reduction in fertility. The medications used to manage some chronic illnesses can cause nutrient depletions and affect hormones which can increase the time it takes to get pregnant. Nonsteroidal anti-inflammatory medications (NSAIDs) for example can cause temporary infertility and corticosteroids are associated with an increased time to get pregnant in some rheumatic diseases. As a clinical nutritionist, assessing your nutrient status and potential deficiencies caused by medications and treatments is a vital part of your preconception treatment plan.
Often people with chronic illnesses are older when trying to conceive which can also have an impact on fertility. Many age-related fertility factors, such as egg and sperm quality and reducing the risk of miscarriage and complications can be assisted with the correct nutritional support.
Preconception is an important time to be having discussions with your healthcare team as you plan and prepare for pregnancy. Ideally, this period is at least 3 months. You’re going to want to discuss any medications you’re currently taking and if they’re safe to be taken during pregnancy, and if not what alternatives are available. This is an ideal time to work alongside a clinical nutritionist to correct any nutritional deficiencies, ensure your nutritional status is optimal for conception and pregnancy, improve your egg and sperm quality and reduce the likelihood of pregnancy symptoms and complications. This also reduces the time taken to be pregnant and improves your health and wellbeing during pregnancy.
When you’re planning your pregnancy team, it’s important to build a team around you with good communication, who you can trust to guide you through your pregnancy. You could be spending a lot of time with these people and having a team you can trust is known to enhance your experience through pregnancy. Many women with chronic health conditions reflect positively on their healthcare practitioners when they have good interpersonal skills, aren’t too medicalised (unless it is safest for the baby) and take a holistic approach. At this stage, your team may include a gynecologist/obstetrician, GP, clinical nutritionist, psychologist, and acupuncturist.
Everyone experiences pregnancy differently and depending on the illness/es that you experience, you can expect different things in your pregnancy. For people who have an autoimmune disease and subsequently become pregnant, pregnancy can bring significant improvements, such as in rheumatoid arthritis and multiple sclerosis, or exacerbate or have no effect on other autoimmune diseases like systemic lupus erythematosus (SLE).
The overall goal of living with chronic illness is to manage symptoms and prevent situations that exacerbate the underlying illness. Although women with chronic illness may experience a variety of symptoms, depression and fatigue are common which can be exacerbated in pregnancy. Managing your stress levels during pregnancy is important for your own health and wellbeing and that of your little one too. Connecting with a psychologist who has experience with chronic illness and/or antenatal care can be valuable. Some people experience a sense of loss of control of their condition that they had learned to manage prior to pregnancy, and this can bring about many challenges.
Choosing a model of care that works for you during pregnancy and supports the labour and delivery you want is very important. There are many options for models of care in Australia including midwifery-led care, GP-shared care, private midwife care, private obstetric care and public hospital maternity care. The healthcare team you work with during preconception care will be able to support you in various models of care.
Although some chronic illnesses can increase the risk of complications, not all pregnancies in women with chronic illnesses are high-risk pregnancies. Some chronic illnesses such as diabetes, thyroid disease, seizure disorders, and kidney disease can increase the risk of gestational hypertension and preeclampsia. Though we can’t manage all risk factors for these conditions, there are still some risk factors we can address to reduce the likelihood of them occurring.
There is no indication people with a chronic illness are more or less likely to have a caesarean section or spontaneous birth. There is also no correlation between chronic illness and time spent in hospital during pregnancy. So there is every likelihood you can have a healthy pregnancy with chronic illness!
Postpartum can be a challenging time for anyone, let alone managing a chronic illness at the same time. There are many nutritional depletions that happen during pregnancy and delivery that can increase symptoms of fatigue, depression, and anxiety. Many women experience self-doubt during this time which is increased by concerns about how to care for a baby, fulfil motherhood responsibilities and manage their own health.
Some women will experience a reduction in symptoms of their chronic illness during pregnancy which can extend to the postpartum period. Pregnancy is able to influence the onset and progression of autoimmune and inflammatory diseases by influencing the T cell cytokine-mediated responses during pregnancy, the postpartum period, and for decades after pregnancy. Everyone experiences postpartum differently and it’s important to be prepared!
Keeping a supportive team around you during the postpartum period and prioritising your health is crucial for your family’s health and your health now and in future pregnancies. Having your postnatal blood tests done, having a pelvic floor assessment with a women’s health physiotherapist and seeing a clinical nutritionist to make sure you’re meeting your nutritional requirements supports you to be the best mum you can be. There is also specific postpartum support like postpartum doulas and lactation consultants you might like to reach out to during this time.
It’s important to remember many mums are able to be wonderful parents even with the challenges of chronic illness!
If you’re interested in taking any supplements, please discuss this with your practitioner to ensure you’re taking the correct dose and form for you. This article is not intended to be medical advice and is purely for education purposes.