Family Planning with a Chronic Illness

Erica Lemons knew her path to motherhood wasn’t going to be easy. But she wasn’t going to let her chronic health condition stop her from getting pregnant.

“My doctor told me to talk to him before I got pregnant because of possible complications, so that was the first thing I did,” she said.

Lemons quickly learned that trying to get pregnant with a chronic illness was going to be even more complicated than she thought. For starters, she had to stop taking the medications she was taking for her chronic illness and she had to wait months before she could get pregnant.

“I was shocked; I didn’t realize how long I had to stop taking the medication before I could even try it,” she said. “My advice to anyone thinking about getting pregnant is to talk to your doctor as soon as possible. You may have to wait longer than you think.”

Nearly 3 out of 10 women and people assigned female at birth in the US live with multiple chronic conditions. These conditions usually require medication, so it’s important to talk about family planning with your healthcare provider (HCP), even if it’s just a possibility for the future. Your doctor may prescribe more aggressive treatments that may not be the best option if you are considering getting pregnant in the future.

Unfortunately, not all healthcare professionals ask about pregnancy planning. This can be due to many factors, including a lack of time, knowledge and skills to start the conversation. In one review of pregnancy planning and women living with chronic illnesses, women said their health information needs were not being met. And they wanted to have better conversations with their healthcare professionals.

What is shared decision making?

Shared decision making occurs when you decide your treatment path after a thorough conversation with your doctor. This is especially important for people with chronic illnesses who are planning a family.

Health care professionals manage your health before, during and after pregnancy and provide guidance that can influence family planning. “Some diseases get worse during pregnancy and others get better, and knowing this would help you determine a good time to start trying to get pregnant,” said Connie Newman, MD, associate professor of medicine at New University Grossman School of Medicine. York and a member of HealthyWomen’s Women’s. Health Advisory Council.

Chronic health conditions last more than a year and can include a wide range of diseases, from multiple sclerosis (MS) to diabetes and high blood pressure. Both the condition and the medication can affect the pregnancy and your ability to get pregnant in the first place. Some medications can cause serious problems during pregnancy, such as premature labor and birth defects.

Read: Can living in the US increase the risk of preterm birth? >>

“Patients should inform their doctor about their pregnancy plans and ask if the prescribed treatment is safe during pregnancy. If the answer is no, then the patient can ask about taking a different medication that he or she is safe to use,” Newman said. “Patients should also ask themselves whether the disease will worsen during pregnancy and how their medications should be adjusted.” Changes may include the dosage, how many times you take it, and/or a completely different medication.

Questions to ask your healthcare provider about chronic illness and pregnancy

If you haven’t talked to your doctor about your plans, you may want to schedule an preconception counseling visit. During the appointment, your doctor will review your treatment plan and how pregnancy may affect your overall health.

Newman said it’s a good idea to write down any questions you have about your pregnancy and bring them to your appointment. These may include:

  • Will my condition get worse during pregnancy or get better? And when will this happen (first, second or third trimester)?
  • Will the medication I am taking be harmful during pregnancy, even in the early stages of pregnancy, even before I know I am pregnant?
  • Can you describe the risks of the medication?
  • Will I have to stop the medication or switch to another medication when I am pregnant? Should I do this when I’m trying to get pregnant or after the pregnancy test is positive and I’m sure I’m pregnant?
  • Can I breastfeed while taking this medication?

You can also talk to your doctor during your good visit if you haven’t already.

Weigh the risks and benefits of treatment options

Weighing the risks and benefits of treatment is a crucial part of the shared decision-making process. “The doctor and patient should discuss the risks and benefits to determine a plan for medication use during pregnancy,” Newman said.

In addition to talking to their doctor, Newman said women can read about the potential effects of treatment options using reliable online sources, including the patient information portion of the medication label or medication labels written for the prescribers.

Managing chronic conditions may also mean involving specialists and other health professionals in your family planning process. Lemons said her doctor connected her with a fertility specialist, for example, and other health professionals along the way. She said she appreciated all the frank conversations they had and that her support meant a lot at a time when she felt so overwhelmed.

Lemons gave birth to a healthy baby in 2012. She said all the planning, waiting and anxiety wasn’t easy. But nothing is exactly easy when you’re pregnant and managing a chronic illness. “Just remember to be kind to yourself and your mental health,” she said. “Put yourself first.”

This educational resource was created with the support of Viatris, member of the HealthyWomen Corporate Advisory Board.

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