Here’s Why Women with Arthritis Are Less Likely to Have Children

A recent study published explored reproductive habits and the reasons behind them in women with inflammatory arthritis. The study concluded that, for most women, their diagnosis affects their decision to start a family.

“Women with inflammatory arthritis appear to have fewer children as compared with healthy women, but few studies have assessed how patients’ attitudes and decision making influence their family sizes,” the study authors wrote. “Little is also known about how patients experience other aspects of their reproductive lives, such as menstruation and contraception.”

The study, published in ACR Open Rheumatology, was a collaborative effort between CreakyJoints and ArthritisPower.

“Despite significant improvements in the identification and treatment of inflammatory arthritis, this study suggests that the diagnosis all by itself makes women rethink how they want to build their families,” said study author Megan E.B. Clowse, MD, MPH, a rheumatologist at Duke School of Medicine, in a press release.

The research team surveyed women with inflammatory arthritis. The final analysis included responses from 267 women (mean age, 39.6 years; mean age at diagnosis, 27.2 years). Most respondents had rheumatoid arthritis (79%); others reported juvenile idiopathic arthritis (14%), psoriatic arthritis (11%), ankylosing spondylitis (9%), and inflammatory bowel disease-associated arthritis (6.4%). A little more than a quarter (27%) of respondents reported at least one pregnancy after their arthritis diagnosis, 40% reported infertility, and 93% had tried at least one conventional or biologic disease-modifying antirheumatic drug prescribed for their disease.

Arthritis Diagnosis Influences Decision to Have Children

More than half (n = 149, 58%) of women reported that their disease diagnosis did in fact affect their decision to have children, or the number of children they wanted to have. Among this group, multiple concerns were reported:

• Would be unable to care for the child (n = 126, 85%)
• Antirheumatic drugs would harm a baby (n = 91, 61%)
• Child might inherit arthritis (n = 77, 52%)
• Arthritis might cause premature death of the patient so that she could not raise her child(ren) (n = 51, 34%)
• Arthritis might directly harm a developing baby (n = 47, 32%)
• Physician counseled against pregnancy (n = 24, 16%)
• Infertility (n = 18, 12%)
• Pregnancy loss (n = 15, 10%)
• Fear of arthritis flare during or after pregnancy (n = 13, 9%)
• History of pregnancy complications (n = 2, 1%)

“Women who wanted fewer children because of their arthritis differed from other women in the sample: they were diagnosed with their arthritis at a younger age, had used more medications since the time of diagnosis, and were younger at the time that they completed the ArthritisPower survey (P < 0.05),” the researchers observed.

A total of 96 respondents (37%) said that their arthritis played no role in how many children they wanted to have:

• Had children before arthritis diagnosis (n = 49, 51%)
• Arthritis does not affect pregnancy decision making (n = 31, 32%)
• Never wanted children (n = 9, 9%)
• Plan to adopt or have adopted (n = 8, 8%)

The remaining 12 respondents (5%) said they had not yet thought about having children.

“As physicians, we need to do a better job addressing patients’ concerns about perceived childbearing risks related to disease onset and treatment,” said Dr. Clowse. “Most existing studies show that women with inflammatory arthritis can have healthy pregnancies and children, particularly if their disease is well controlled at the time of conception. We’d also benefit from studying more closely why women with inflammatory arthritis seem to experience increased risk for infertility.”