Pregnancy and Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2020 | Last updated: June 2021

If you’re thinking about starting a family but also live with an AxSpA spectrum condition, you might have questions about how the condition will affect your pregnancy, whether pregnancy is possible, and much more. You might be concerned about disease flare-ups or dealing with symptoms, or you might be thinking about post-birth and what that might be like, in terms of your AxSpA.

These are all normal concerns, and it’s important to talk with your doctor about your plans for pregnancy. Before you and your partner start trying for a baby, talk with your doctor about your timeline and when you’d like to start trying to conceive. Some medications might not be indicated for pregnancy, and it’s important to stop taking those medications enough in advance to safely conceive. Most medications are fine and do not affect fertility, but it’s always a good idea to make sure.

Data on pregnancy outcome in people with AxSpA spectrum conditions is lacking.1 While there are studies on pregnancy outcome and other kinds of rheumatic disease, AxSpA spectrum-specific studies need to be done.

Symptoms and medications

In some people with immune-related disorders, pregnancy-related immune system changes can sometimes ease symptoms, as seen with rheumatoid arthritis (RA).1 No such changes have been seen thus far in AxSpA spectrum conditions.1 Symptoms have been reported in 60 to 80 percent of pregnant people with AxSpA spectrum conditions, with worsening of pain and morning stiffness.1

Stopping certain medications during pregnancy can also cause symptoms to flare-up, especially in the first and second trimesters. In order to control disease symptoms, medications compatible with pregnancy should be used.1

Staying active during pregnancy is important for every pregnant person, but especially if you have an AxSpA spectrum condition. It will benefit your overall health as well as your AxSpA.


Labor and childbirth are not generally affected by AxSpA spectrum conditions. Even with hip or SI involvement or issues, this typically does not affect your ability to have a vaginal birth. You can use a variety of positions that may promote joint comfort or overall physical comfort; talk with your OB or midwife about these options.2

If you’re concerned about pain relief during labor and childbirth, this is also something worth discussing with your provider. Sometimes epidural placement can be tricky in people with AxSpA spectrum conditions, but your provider will be able to examine this in depth with you, as well as provide you with other options.2 Sometimes elective Cesarean births are done in those with inflammatory joint disease, but this can vary.2 You and your provider will be able to work together to come up with a plan for your birth experience that will give you support and pain relief.

Things to consider with AxSpA

Your doctor may speak with you about the genetic risks of passing on a gene that is associated with AxSpA spectrum conditions. It’s also important to remember, though, that many people with said gene do not develop AxSpA spectrum conditions, and genetics is only one part of the puzzle.

It has been found that approximately one-third of women with ankylosing spondylitis (AS) have a flare-up of their symptoms in the months after childbirth.3 Even if you don’t have AS, living with AxSpA can have its own challenges, let alone when you’re adjusting to life with a newborn. If this is something you’re worried about, talk with your doctor about a plan for symptom control, especially if you are planning to breastfeed. Some medications may not be able to be taken while nursing. Planning ahead for some extra support at home in taking care of your child can help relieve the physical burden, especially if you start to be symptomatic.

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