What to Expect When You’re Expecting: Navigating Pregnancy and New Motherhood with PsA

Jenny Durand shares her experience navigating pregnancy and postpartum life with psoriatic arthritis (PsA).

I’ve had psoriasis since I was 12 and was diagnosed with PsA 3 years ago when I was 26. Even with years of dealing with this condition, I didn’t hear many people talk about the anxiety around how pregnancy and motherhood can affect you when you have PsA.

That’s why I became an advocate, to let others know what to expect. For example, I work at a dermatology clinic, and when pregnant people come in, the doctors always ask if they want to talk to me and get my experience. I’m so happy to share my story with them.

Knowing that someone has been through what you’re about to experience is so valuable. It can make you less nervous. So, here’s my journey toward becoming a mom, which started years before I had my daughter.

Join the free PsA community!

Connect with thousands of members and find support through daily live chats, curated resources, and one-to-one messaging.

Sign up

Prepping for pregnancy

When I was initially diagnosed with PsA, I wasn’t thinking about how it might affect my fertility or a future pregnancy. But it was in the back of my mind that methotrexate might not be a good option and could delay getting pregnant when that time came. I also worried that I would never get pregnant if I took that medication.

Fortunately, my doctors explained that’s not true. You can get pregnant after taking it, just not during. So, after I got married and we started talking about having a baby, I went off methotrexate about 4 months before we began trying. In that time frame, I had appointments with my rheumatologist, OB-GYN, and primary care doctor to make sure we were all on the same page in terms of what was needed to prepare my body for this.

I got up to date on my immunizations and began taking Cimzia because that had the most research on safety in pregnancy. With that switch, I was concerned about losing some ground in terms of controlling my PsA because before I was diagnosed, I was very active as a runner and doing intense training. The condition left me barely able to walk, and I’d gotten more mobility with methotrexate but had concerns about going back to that limited activity.

Fortunately, Cimzia turned out to be my best medication so far. I was even able to run again, which was a really great surprise. But the most important part of that medication change was that I felt ready to be pregnant and become a mother.

Navigating the trimesters

When I got pregnant, the PsA flared in my feet, which hadn’t happened in a long time. In fact, that’s what made me suspect I was pregnant, even before I took a pregnancy test. When you have PsA, you’re so in tune with your body and used to listening to what it’s trying to tell you, so that flare was like a sign that a huge shift had occurred.

The flare continued in the first trimester, which was tough, but at least I didn’t have nausea. I was working as a nurse at the time, and the joint pain combined with being in a busy infusion suite got very difficult. I felt like the pregnancy worked against me.

But in the second trimester, the joint pain completely went away. While that was a relief, my anxiety surged. I know that anxiety is part of my PsA, and it had been pretty well controlled prior to pregnancy, but with the hormone shift, it became a little overwhelming. I was so afraid I’d do something wrong to hurt the pregnancy that I wouldn’t even take Tylenol for my joint pain. I just gritted my teeth through it.

Another contributor to the anxiety was difficulty sleeping and walking. When you’re pregnant, there’s loosening in your ligaments. There was one deep in the groin that bothered me the most and was painful from week 28 onward. I think I slept with 18 pillows to try and alleviate that, but even then, I still struggled to get the kind of restorative sleep I needed.

Because the anxiety felt so consuming, I ended up switching therapists and seeing one who specializes in women’s health, particularly pregnant people. That made a huge difference to be able to talk about it and have someone who not only listened but also challenged me in some ways to explore my feelings about everything. For anyone going through pregnancy, particularly with a chronic condition, I’d suggest this approach because you’re going through so much. It’s important to have that kind of support.

Postpartum life

Before I went into delivery in January, I spoke with my OB-GYN about my positioning because when I lay on my back, my SI joint gets really angry. I was nervous that being flat would aggravate that. My whole team was so responsive and on board to try different positions to make me comfortable.

I also met with a pelvic floor specialist to talk about what positions would be most helpful. As it turns out, when you’re in labor, you don’t care. You just want to have that baby.

In terms of postpartum challenges, lack of sleep is the root of all the issues. Previously, when I did night shifts as a nurse, I had to switch because that’s when my arthritis was at its worst. Being up with my daughter during the night made me have to deal with that again, and even being on Cimzia can’t take away the stress of not sleeping.

When you’re tired like that, you can feel the inflammation flaring. I’ve been getting used to working with less energy, but it’s difficult.

Sometimes, my hands and lower back flare when I’m holding my daughter. I’ve had to come up with some strategies where I put her down more often than I like, but it’s necessary to reduce that pain and inflammation.

Beyond that, I think what’s most important is to keep reminding myself I’m a good mom and I’m doing a good job. Everyone who’s had a baby and has PsA needs to hear this. You get stretched thin, and it’s easy to feel like you’re not doing enough. It’s also easy to fall short of taking care of yourself. But it’s crucial to build your support team and to remember that you’re juggling a lot.

Planning for self-care is a big part of managing PsA in general. It’s particularly essential when you’re going through pregnancy and handling being a parent, so this is my biggest advice:

• Take care of yourself.
• Make sure you have support where you need it.
• Never stop reminding yourself that you really are a good mom.