Your Guide to Family Planning with Autoimmune Disease

If you’re living with a long-term health condition, thinking about starting a family can bring up a lot of questions. Living with rheumatoid arthritis or another autoimmune condition adds complexity but it does not remove possibility. Family planning decisions are deeply personal however with early conversations, coordinated care, and informed decision-making, you can approach this chapter feeling supported rather than overwhelmed.

Why Family Planning Conversations Matter Early

Conversations about family planning with a rheumatology condition should start well before trying to conceive. While medications used to manage inflammatory arthritis, and other autoimmune conditions are highly effective for controlling disease activity,

some are not safe during pregnancy. Others may need to be adjusted months before conception. Waiting until you are already trying to fall pregnant can create unnecessary stress and risk.

Proactive planning allows your healthcare team to:

Review and adjust medications safely

Aim for low or stable disease activity before conception

Reduce the risk of complications during pregnancy

Support you in making informed, confident decisions.

If family planning may be part of your future, it’s worth raising with your rheumatologist.

Medication Safety: What You Should Know

Medication concerns are one of the most common sources of uncertainty for people with rheumatology conditions.

Some treatments can be safely used in pregnancy. Others must be stopped well in advance. Importantly, stopping medication without medical supervision can increase disease activity, which itself can impact fertility and pregnancy outcomes. Never stop or change medication without speaking to your care team.

Download the current advice sheet from the Australian Rheumatology Association on safe medications during pregnancy to discuss with your rheumatologist.

Timing and Disease Control

Pregnancy outcomes are generally better when conception occurs during a period of low disease activity or remission.

If you are experiencing flares, significant fatigue, or increased inflammation, it may be safer to stabilise your condition before trying to conceive. While this can feel frustrating, it significantly improves outcomes for both the parent and the baby. Talk to your rheumatologist about what ‘low disease activity’ would look like for you and how to achieve this goal before conception.

Building the Right Support Team

Family planning with a rheumatology condition should never feel like something you navigate alone.

A strong support team may include:

Your rheumatologist

A GP who understands your condition

An obstetrician who specialises in high-risk or complex pregnancies

Allied health professionals

Emotional and peer support networks.

Open communication between providers ensures coordinated care. Don’t hesitate to ask your doctors to collaborate directly if needed.

Equally important is emotional support. Decisions around pregnancy, medication, and timing can feel overwhelming. Connecting with others who have walked this path can reduce isolation and provide reassurance.

You may be able to connect with someone on a similar journey to you through our Peer Mentor Support Program or online support groups.

Pregnancy

Some people with a rheumatology condition experience improvement in symptoms during pregnancy, while others may not.

If arthritis affects your back or hips, you may notice more pain in those joints as your baby grows which could place more stress on affected joints.

If you experience a flare during your pregnancy, it is important to seek advice from your support team for things like medication, physiotherapy, pacing and required rest to achieve the best outcomes for you and your baby.

You may also have more frequent monitoring from your health team than someone without a rheumatology condition. This can include:

Regular blood work

Monitoring of disease activity

Growth scans for the baby

Blood pressure checks.

While extra appointments can feel overwhelming, they are designed to provide reassurance and early detection of any concerns.

Birth

Some people with arthritis may have a vaginal birth, while others may be advised a caesarean section may be the best option for a healthy baby. Each birth is unique and various factors may influence delivery planning, such as:

Severe hip or spinal involvement

Significant joint damage affecting mobility

High disease activity

Other medical complications.

It’s important to discuss a birth plan early with your obstetric provider, including:

Pain management options

Mobility considerations during labour

Fatigue management

Support person planning post-birth.

Post-Partum

While often a lot of the focus is on pregnancy, the postpartum period is often the most physically and emotionally demanding stage, especially for people with autoimmune conditions. Many individuals find they experience a flare within the first three to six months after giving birth. This is thought to be related to hormonal shifts and immune system changes after pregnancy.

Before birth, discuss:

When to book in the first rheumatology appointment post-birth

When medications will be restarted or adjusted

What treatments are compatible with breastfeeding

How flares will be managed with your support team

What practical support you will have at home.

Whether to breastfeed or not, or for how long, is a very personal decision. Discuss your plans early with your rheumatologist so that your treatment plan can be aligned with your preferences. There is no single “right” choice. The right decision is the one that supports both parent and baby safely.

Sleep deprivation, physical recovery from birth, and the physical demands of caring for a newborn can all strain joints and increase fatigue. Lifting, feeding, and carrying your baby repeatedly throughout the day can trigger pain or inflammation.

Practical strategies can help reduce the load, including:

Setting up your home ergonomically to avoid excessive bending and lifting

Using supportive pillows when feeding

Finding a lighter weight pram and baby carrier

Setting up baby changing stations around the house to reduce walking around

Preparing freezer meals before birth

Accepting help from others with household tasks

Scheduling follow-up appointments early

Reaching out for support when needed https://www.panda.org.au/ or call 1300 726 306.

Practical Next Steps

If family planning is on your horizon, or even a possibility in the coming years, here are four important steps you can take:

Start the conversation early.
Bring up family planning at your next rheumatology appointment, even if you’re not ready to conceive yet.
Review your medications with your health team.
Ask which medications are pregnancy-compatible and whether any require changes in advance.
Aim for stable disease control.
Work with your care team to reach low disease activity before trying to conceive and ask what low disease activity would look like for you and your condition.
Watch our latest webinar on family planning.
Rheumatology Nurse Consultant Linda Bradbury walks us through the key insights when it comes to planning, pregnancy, birth and post-partum. Click here to watch the webinar.