Ankylosing Spondylitis and Pregnancy: Fertility, Medication, and More
Rheumatic ConditionsAnkylosing Spondylitis
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Ankylosing Spondylitis and Pregnancy: What You Need to Know

You're more likely to have a healthy pregnancy if your AS is well controlled from the beginning.
Ankylosing Spondylitis and Pregnancy: What You Need to Know
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Updated on November 15, 2024
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If you’re living with ankylosing spondylitis (AS) and are thinking of conceiving, you may be wondering: Can I have a healthy pregnancy with AS? We spoke with several experts and the answer is reassuring: Yes, most people with AS have healthy pregnancies and babies, but there are some considerations you need to be aware of.

Keep reading to learn everything you need to know about pregnancy with AS, from potential health risks to how the illness might affect you and the baby. Discover how your treatment plan may change, what to discuss with your doctor before you become pregnant, and what you can do to prepare for a successful pregnancy.

What Is Ankylosing Spondylitis?

AS is a chronic autoimmune inflammatory condition that causes pain, swelling, stiffness, and fatigue.

 It affects the spine and sacroiliac joints (where the hip bones attach to the sacrum of the spine), explains Cynthia DeTata, MD, an obstetrician-gynecologist at Stanford Medicine Children’s Health and a clinical assistant professor in Maternal-Fetal Medicine at Stanford Medicine in Palo Alto, California.

“One to 2 percent of the population might have AS,” she says, “and 80 percent of the time, the disease presents itself in people younger than 30. Right at the time when many people consider having a baby.”

Ankylosing Spondylitis and Pregnancy

Besides the usual symptoms of AS, people may be concerned about whether chronic inflammation can affect a person’s ability to get pregnant.

Currently, there’s no evidence to suggest that AS directly affects female fertility.

If a man is taking a medication called sulfasalazine, which is sometimes used to treat AS, he should be sure to speak to a healthcare provider, as it may affect sperm function.

How Might Ankylosing Spondylitis Affect My Pregnancy?

Most people with AS can expect to have normal pregnancies and deliveries. But there are some risks the mother and baby may face. Pregnancies with AS may be slightly more likely to result in:


  • Preterm birth
  • Cesarean sections
  • Babies with low birth weight

  • More babies being admitted into the neonatal intensive care unit (ICU)

The risks of these complications are higher in people with more AS symptoms (also called “higher disease activity”), people with other medical conditions, or those who develop preeclampsia (very high blood pressure during pregnancy).

Can Pregnancy Make Ankylosing Spondylitis Worse?

Pregnancy can worsen AS symptoms for some, but it can ease them for others. “Disease activity during pregnancy can vary,” says Alireza Meysami, MD, the head of rheumatology at Henry Ford Health in West Bloomfield and Detroit, Michigan. “Some women may see improvement, while others experience stable or worsened symptoms, and postpartum flares are common.”

“Back pain, which is common in pregnancy, can get worse in AS,” adds Dr. Meysami, “making it essential to differentiate between typical pregnancy-related discomfort and AS flares.”

Is It Safe to Take Ankylosing Spondylitis Medication While Pregnant?

Certain medications for AS are safe during pregnancy, while others may have to be avoided or considered carefully with your doctor.

For example, TNF inhibitors are generally stopped during the third trimester so that the infants immune system is not suppressed during birth. Please be aware that several anti-TNF medications cross the placenta which is usually not an issue until the third trimester. Certolizumab (Cimzia) is an anti-TNF that minimally crosses the placenta and may be a medication deemed more appropriate to continue through pregnancy.

But continuing some disease-modifying antirheumatic drugs (DMARDs) may be helpful, notes Dr. DeTata. “Importantly, these medicines might prevent a ‘flare’ or worsening of the disease.”

As for NSAIDs, “these can be used up to a certain point in pregnancy but are generally avoided in the third trimester,” says Meysami. Overall, “It's important to work with a rheumatologist to tailor the treatment plan, balancing disease control with fetal safety.”

Elaine Husni, MD, MPH, the vice chair of rheumatology and the director of the Arthritis & Musculoskeletal Center at the Cleveland Clinic, agrees. The important thing, she says, is to make sure your disease is as stable as possible — both for your health and comfort, and for your baby’s. “The healthier you are when you get pregnant and while you’re pregnant, the better your outcomes are likely to be,” Dr. Husni says.

How Will Ankylosing Spondylitis Affect My Baby?

If you have a close family member with AS, you're more likely to develop the condition. So, there’s a chance that your child might develop AS, but remember that the condition isn’t entirely genetic: Many environmental factors play a role.

If you have AS there’s a 1 in 2 chance you’ll pass on the gene to your baby. But, having the gene doesn’t mean your baby will go on to have the condition itself. In fact, 75 percent of children who inherit the AS gene from a parent don’t ever develop the disorder.

Will I Be Able to Breastfeed With Ankylosing Spondylitis?

If you are breastfeeding, you should check with your healthcare provider if it’s okay to continue taking some AS medication. Some medications come with a recommendation to stop taking them during breastfeeding, while with others it’s okay to continue. A doctor will be able to advise on the specifics of the medication you're taking.

Be sure to speak to your healthcare professional or a lactation specialist if you’re having trouble breastfeeding.

How Can I Manage My Ankylosing Spondylitis While Caring for a Newborn?

Newborns need round-the-clock care, and balancing their needs with yours can be challenging. Remember that taking care of yourself is especially important — if you’re healthy and comfortable, you can better look after your child. Here are some tips to help you manage AS while caring for your baby.

  • Have a care plan in place before the pregnancy, including ways to manage flare-ups.
  • Get all the support you can: rely on your partner, family, and friends.
  • Take your medications as instructed by your doctor.
  • Eat a healthy diet.
  • Nap when the baby naps.

The Takeaway

  • Most people with AS have healthy pregnancies and babies. While some risks and complications are possible, there are many things you can do to prepare for a successful pregnancy.
  • First of all, planning is key. “If you’re considering a pregnancy,” DeTata says, “make an appointment with an obstetrician who specializes in complex pregnancies.”
  • Also be sure to review which medications are safe during pregnancy and breastfeeding, and while you're trying to conceive. Some may need to be discontinued or changed.
  • Remember that you’re not alone and support is available.

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Beth Biggee, MD

Medical Reviewer
Member of American College of Lifestyle Medicine, Castle Connolly Top Doctor

Beth Biggee, MD, is medical director and an integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice for people residing in California and Pennsylvania. This first-of-its-kind company offers whole person autoimmune care by a team of integrative rheumatologists, lifestyle medicine practitioners, autoimmune dietitians, psychologists, and care coordinators.

Dr. Biggee also works as a healthcare wellness consultant for Synergy Wellness Center in Hudson, Massachusetts. Teamed with Synergy, she provides in-person lifestyle medicine and holistic consults, and contributes to employee workplace wellness programs. She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.

Dr. Biggee graduated cum laude with a bachelor's degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, completed her fellowship in rheumatology at Tufts–New England Medical Center, and completed training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine. Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, attained board certification in integrative medicine through the American Board of Physician Specialties, and attained accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework for the Aloha Ayurveda integrative medicine course for physicians.

In prior roles, Dr. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and instructed "introduction to clinical medicine" for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.

Dr. Biggee has published in Annals of Rheumatic Diseases, Arthritis in Rheumatism, Current Opinions in Rheumatology, Journal for Musculoskeletal Medicine, Medicine and Health Rhode Island, and Field Guide to Internal Medicine.

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Ana Sandoiu

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Ana is a freelance medical copywriter, editor, and health journalist with a decade of experience in content creation. She loves to dive deep into the research and emerge with engaging and informative content everyone can understand. Her strength is combining scientific rigor with empathy and sensitivity, using conscious, people-first language without compromising accuracy.

Previously, she worked as a news editor for Medical News Today and Healthline Media. Her work as a health journalist has reached millions of readers, and her in-depth reporting has been cited in multiple peer-reviewed journals. As a medical copywriter, Ana has worked with award-winning digital agencies to implement marketing strategies for high-profile stakeholders. She’s passionate about health equity journalism, having conceived, written, and edited features that expose health disparities related to race, gender, and other social determinants of health.

Outside of work, she loves dancing, taking analog photos, and binge-watching all the RuPaul’s Drag Race franchises.

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Resources
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  5. Redeker I et al. Maternal and infant outcomes in pregnancies of women with axial spondyloarthritis compared with matched controls: Results from nationwide health insurance data. RMD Open. July 2022.
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