FAQ's About Pregnancy and Fibromyalgia

December 19, 2010

Brian A. Mason, MD, FACOG, is an Associate Professor at the Division of Perinatology at Wayne State University in Detroit, Michigan, and a perinatologist (high risk obstetrician) at the Division of Maternal-Fetal Medicine at St. John Hospital and Medical Center in Detroit, Michigan. The following is a question and answer interview regarding pregnancy and fibromyalgia.

Q: Can FM Affect A Pregnancy? How?

A: Yes. Although there is severely limited research in this area I would like to share some related studies.

Some studies indicate reduced fertility rates among FM patients. One study found an unexplained lower fertility rate in FM patients with myofascial pain syndrome.

Source:
"Co-morbid FM accounts for reduced ability to get pregnant"
Clinical Journal of Pain, Vol. 16, pgs 29-36, March 2000
New Jersey Medical School

Another study followed how various hormone events affected FM. Twenty-six women with FM and a total of 40 pregnancies were studied. The women in the study found FM symptoms to be worse in the 3rd trimester of pregnancy (with the exception of 1 patient). In 33 of the 40 pregnancies, the women ultimately returned to the same level of FM symptoms prior to pregnancy.

There was an increase in depression, and anxiety during postpartum for the women studied. This did not affect the pregnancy or the health of the baby.

Seventy-two percentof patients had worsening FM symptoms just before menstruation. This is interesting because this mimics the changes that occur in the third trimester of pregnancy-where the majority of women studied had increased FM symptoms.

Source:
"Effect of Reproductive Events and Alterations of Sex Hormone Levels on Symptoms of Fibromyalgia"
Scandinavian Journal of Rheumatism, Vol. 26, 1997

Q: Does Stress Trigger Fibromyalgia During Pregnancy?

A: Pregnant or not, stress -- both physical and emotional -- is known to trigger fibromyalgia. Considering all that's involved with pregnancy, labor, and delivery, it's obvious that pregnancy is a time of high stress. With pregnancy, there are changes in the levels of estrogen, progesterone, and other hormones. Also, since the time after a pregnancy can be difficult for mothers -- even those without fibromyalgia -- it's important to be aware of the possible increase in pain and other symptoms that may occur after giving birth.

Source:
Fibromyalgia and Pregnancy
©2005-2011 WebMD, LLC. All rights reserved.

Q: How Can You Control The Pain Of FM During Pregnancy? Are Certain Pain Relief Drugs Safe During Pregnancy?

A: Yes, certain pain relief drugs can be used during pregnancy as well as trigger point injections.

Relatively speaking, narcotics can be used in pregnancy. The risk for birth defects, when the drugs are used appropriately, is limited. Thus narcotics are generally safe in pregnancy. More controversial are NSAIDs. If they are used at all during a pregnancy they MUST be discontinued by the end of the second trimester. Tylenol can be used-but appropriately. Don't exceed 4 grams a day (which would equal 2 extra strength pills every 6 hours per day). Aspirin is similar to the NSAIDS. A low dose may be appropriate, but it must be discontinued by late second trimester. Ultram also can be used.

Non-drug options are the best and safest pain relief solution during pregnancy. But this does not mean that patients and doctors should shy away from using medications. One weighs risks and benefits all the time. If the benefit of a medication can be life-changing, and life-improving, then I think it is reasonable to use during pregnancy.

Examples of non-drug options: meditation, aerobic activity, yoga, focused breathing, physical therapy, certain forms of massage (make sure the therapist knows FM and how to safely perform massage on a pregnant patient). Some heat therapies are appropriate-like a warm bath. The water must not exceed 100 degrees Fahrenheit, and exposure should be limited to 15-20 minutes. Note that electric heating pads and blankets are prohibited during pregnancy.

Source:
Sharon Waldrop, Q&A with High-Risk Obstetrician Dr. Brian A. Mason
National Fibromyalgia Association.

Q: What Treatments Are Recommended for Fibromyalgia During Pregnancy?

A: To avoid letting fibromyalgia interfere with pregnancy, know what steps you can take to ease the symptoms. Then seek support from your doctors, family members, and friends. The safest treatments for pregnant women with fibromyalgia may include massage, exercise, yoga, meditation, and rest.

If you suffer with fatigue and ache all over, make sure you rest 20 to 30 minutes at least two or three times a day. To ease the achiness of tender point pain, try moist heat applications twice a day. A warm shower or bath is a good way to apply moist heat. Also, use gentle stretching exercises and exercises recommended by your doctor for relief.

Source:
Fibromyalgia and Pregnancy
©2005-2011 WebMD, LLC. All rights reserved.

Q: Why Is Exercise Important for Fibromyalgia and Pregnancy?

A: Exercise helps keep you fit. It strengthens muscles, keeps joints flexible, and boosts mood by increasing serotonin in your body. Serotonin is a neurotransmitter that scientists have found to be related to fibromyalgia. Neurotransmitters are chemicals that send specific messages from one cell to another. While only a small percentage of serotonin is located in the brain, this neurotransmitter is believed to play a vital role in mediating moods.

Too much stress can lead to permanently low levels of serotonin. That, in turn, can lead to aggression and feelings of depression. Lack of exercise can aggravate low serotonin levels. On the other hand, increased levels of serotonin in the brain are associated with a calming, anxiety reducing effect. In some cases they are also associated with drowsiness. Having a stable level of serotonin in the brain is linked with a positive mood.

Source:
Fibromyalgia and Pregnancy
©2005-2011 WebMD, LLC. All rights reserved.

Q: What Exercises Can I Do With Fibromyalgia During Pregnancy?

A: Along with stretching and normal daily activities during pregnancy, consider exercising in a warm swimming pool. The heat might help ease the fibromyalgia pain while the stretching and other low-impact exercise can keep your muscles and joints flexible and strong.

The water temperature should feel comfortable but not hot. In a pool, water temperatures from 83 to 88 degrees Fahrenheit are usually comfortable for exercise. But if you're pregnant, ask your doctor. Do not use a whirlpool bath or spa or hot water in your bath during pregnancy. Doing so could harm fetal development.

Other exercises that might be helpful include riding a stationary bike, tai chi, and yoga.

Source:
Fibromyalgia and Pregnancy
©2005-2011 WebMD, LLC. All rights reserved.

Q: Why Do Some Women Report A Reduction Of FM Symptoms During Pregnancy?

A: In pregnancy there is an increase in serotonin and cortisol, which is the body's form of cortisone. This inhibits the body's autoimmune response and perception of pain. We often see women with chronic pain and autoimmune disorders improve during pregnancy.

Source:
Sharon Waldrop, Q&A with High-Risk Obstetrician Dr. Brian A. Mason
National Fibromyalgia Association.

Q: What Advice Would You Have For A Woman With FM Who Is Contemplating Pregnancy, But Also Fears FM Would Make Pregnancy Too Difficult?

A: I would say that she should get the best control of FM symptoms upfront with agents that can be continued during pregnancy. Before the pregnancy is the time to test different drugs. It is a trial and error disease-there is no one best remedy, but if you find what works for you, you will have a better pregnancy.

Set hard limits for yourself. Understand pregnancy is a job in and of itself for a patient with FM. When you are pregnant, you expend much body energy just being pregnant. You can use 1200 to 1400 calories for basic life function before you even take a step, or go to work or begin chasing your kids around the house. Being pregnant is a metabolically fatiguing stage.

Limits are important, too, because it is critical that you do not push yourself past the point of fatigue. This is important for women without FM, so it is especially important for pregnant women with FM. If you plan to breastfeed you will need to consider this point too, because it actually takes more of the body's energy to produce milk than to be pregnant.

Source:
Sharon Waldrop, Q&A with High-Risk Obstetrician Dr. Brian A. Mason
National Fibromyalgia Association.

Q: What Is Your Opinion On Breastfeeding And How It Relates To A Patient With FM?

A: Breastfeeding is best for babies BUT a baby also needs its mother to be functional. Drugs that are used for FM may not be able to be used while breastfeeding. If you need medications to be functional you should use them and bottle-feed the infant. Formulas have come a long way. The bottom line is that breastfeeding is an individual choice, and you should not let anyone make the choice for you.

Source:
Sharon Waldrop, Q&A with High-Risk Obstetrician Dr. Brian A. Mason
National Fibromyalgia Association.

Q: How Can FM Affect Delivery?

A: A woman with FM should be able to have a normal delivery. The important thing will be appropriate pain control. I would recommend the use of epidural analgesics.

Source:
Sharon Waldrop, Q&A with High-Risk Obstetrician Dr. Brian A. Mason
National Fibromyalgia Association.

Q: Because People With FM Are More Prone To Clinical Depression, Should A Woman Be More Concerned About Knowing The Signs Of Postpartum Depression?

A: Sixty to 70 percent of all pregnant women develop the baby blues. Ten percent of women develop clinical postpartum depression. People with an underlying depressive disorder are at a higher risk for developing postpartum depression.

Yes, it is important to seek help if you believe you are experiencing postpartum depression. Indicators of postpartum include a loss of finding pleasure, consuming many carbohydrates, smoking, inappropriate tearfulness, feeling agitated or worthless.

A combination of medications and counseling have been most effective in treating postpartum depression. The good news is postpartum depression is generally short-lived. It is important to know that postpartum depression can actually begin at any time during the pregnancy, not just after the baby is born.

Source:
Sharon Waldrop, Q&A with High-Risk Obstetrician Dr. Brian A. Mason
National Fibromyalgia Association.

Q: What Are The Most Important Things You Can Do To Ensure A Healthy Pregnancy For You And The Baby?

A: The number one leading preventable cause of fetal complications is smoking. Avoid smoke and smoking. Eat a proper diet, get regular prenatal care, avoid toxic agents (which include certain medications), and exercise appropriately.

Source:
Sharon Waldrop, Q&A with High-Risk Obstetrician Dr. Brian A. Mason
National Fibromyalgia Association.

Q: Does A Woman With FM Need To Work With A Perinatologist Rather Than An Obstetrician?

A: No, any obstetrician who is caring, compassionate and insightful is fine. If high risk issues emerge during the pregnancy, the obstetrician can always consult with a perinatologist.

Source:
Sharon Waldrop, Q&A with High-Risk Obstetrician Dr. Brian A. Mason
National Fibromyalgia Association.