By Aysun Alagoz, OB/ GYN

Many fibromyalgia patients are women in their childbearing years who have concerns about the impact of FM on their pregnancies. Unfortunately, there is very little re-search on the subject. Some research indicates that pregnant FM patients have a more difficult time, but there is, as yet, no consensus regarding the effect of FM on pregnancy—or vice versa. One 1997 study from Norway found that expectant mothers who have fibromyalgia have more severe symptoms and are quite uncomfortable during pregnancy. Participants reported that the third trimester was by far the worst, with symptoms increasing in frequency. This continued until about three months postpartum. These women also had a greater incidence of postpartum depression. On a more positive note: the babies born to women with FM were all healthy, full-term, and of a normal birth weight. Karen Moore Schaefer and colleagues at Temple University conducted a survey of 14women in the last trimester of their pregnancies, half of whom had FM. The participants were all between the ages of 29 and 31, and none had a chronic illness aside from fibromyalgia. Surveys asked about the degree of fatigue, pain, and depression the women experienced, and their ability to function. The pregnant women with FM reported having a more difficult time functioning during routine activities than the rest of the group. They complained of feeling more tired and stiff and having more pain in more areas of the body than the women with-out fibromyalgia. This was a small study, but a good start towards understanding the connections between FM and pregnancy. Many doctors who treat fibromyalgic patients argue that pregnancy helps lessen and even eliminate the symptoms caused by FM.

Many pregnant women say that, after their initial nausea and morning sickness passed, they actually felt better than they did before they were pregnant. It is thought that this could be due to the ovarian hormone relaxin.

During pregnancy, the amount of relaxin in a woman’s body increases up to ten-fold. It has been found that relaxin supplements help to ease symptoms in many women with fibromyalgia. According to Dr. Mark J. Pellegrino, one of the nation’s leading experts on fibromyalgia, it takes women with FM longer to recuperate from pregnancy and childbirth. It is not uncommon to experience a flare-up three or four months postpartum. Pellegrino has found that it is the second child that is most likely to cause the flare-up. His theory is that pregnancy is a stress, like a trauma to a fibromyalgia body. “Things are out of sorts during a first pregnancy, but before a bona fide flare-up [can] be established, things [straighten] out,” he said in an interview published in FM Online, the National Fibromyalgia Association’s online newsletter.

“The central nervous system didn’t get a sustained signal, but laid some of the groundwork. It started to form some hypersensitive pathways, but shut it down before the pain amplification process started. Then the second pregnancy comes along, and it’s like the body has been primed the first time. The amplification process starts, and lo and behold, fibromyalgia. The second delivery is the riskiest, both for developing fibromyalgia and for amplifying.”

I am an obstetrician/ gynecologist with fibromyalgia. For me, the postpartum period after my second child created a tremendous flare. I had been diagnosed with fibromyalgia many years earlier, but never had symptoms to the same degree. It took me many months to recover, and the eight months of breast feeding were tremendously exhausting.

Pregnancy and fibromyalgia have overlapping symptoms that can potentially make the pregnancy more difficult for the patient. Backache, severe fatigue, sleep disturbance, and nausea are common in both. According to Schaefer’s study, based on patient interviews, pregnancy was considered difficult due to symptoms such as severe muscle cramping, exaggerated nausea and vomiting in the first trimester, uterine contractions throughout the pregnancy, lack of sleep resulting in fatigue throughout the pregnancy, increased tender point pain due to the baby lying on the trigger point on the hip (located near the trochanter), and increased generalized muscle pain in the third trimester.

The good news is that fibromyalgia will have no negative effect on the baby whatsoever. Women with fibromyalgia should not be discouraged from becoming pregnant. I would recommend having children at a younger age as women over 35 tend to have more difficulties with fatigue, not to mention high risk conditions such as diabetes and hypertension. Women should try to plan pregnancy ahead of time so as to build up their strength. A woman with fibromyalgia should reduce the amount of stress in her life as much as she can. It is recommended to try to conceive when symptoms are less intense—not during a symptom flare-up. As difficult as my second pregnancy was, my two children are the greatest source of my happiness. They keep me going from day to day despite the fatigue and pain. They take care of me and keep me laughing—a wonderful, natural source of pain relief from my fibromyalgia.

2018-07-07T12:52:15-07:00Tuesday, May 29, 2018|Learning Exchange, Uncategorized|