Brunilda Nazario, MD
Amy Louise Nelson, 34, packed on 50 pounds during her first pregnancy and 40 pounds during her second. While she was able to lose the weight rather quickly after she delivered, the extra pounds took a toll on her already damaged joints. Nelson, a stay-at-home mother in Rochester, Minn., was diagnosed with rheumatoid arthritis (RA) 11 years ago. As is the case with many women, Nelson’s RA took a break while she was pregnant.
“Even though I was in remission, I was still abusing my damaged joints with the extra weight I was carrying around,” she says. Any way you slice it, pregnancy is physically hard on the body, and it may be particularly taxing if you have RA, an autoimmune disease that occurs when the body mistakenly attacks its own joints, causing pain, inflammation, and ultimately, joint damage. Gaining weight, whether from pregnancy or at other points during your life, can worsen this joint damage.
The best way to avoid having too much weight to lose post-pregnancy is simple: Don’t gain too much weight in the first place. A total of 25-35 pounds is generally considered a safe amount of weight gain during pregnancy, but you should ask your doctor to see what is a safe amount for you.
Nelson credits breastfeeding for helping her lose her pregnancy weight, and that certainly helps many women. But if you have a flare after delivery and need to take certain medications that aren't safe when breastfeeding, you may not be able to nurse your baby. While RA tends to go into remission during pregnancy, it may flare a few months after the baby is born. Some medications are safe during pregnancy and breastfeeding, while others are not.
Prednisone, a steroid, is on the safe list. But women who take it need to pay attention to their diets and may need supplements, if their doctors recommend them. “A good prenatal vitamin is essential, and if you are taking prednisone, you are at higher risk of bone loss, so you may need more calcium and vitamin D,” says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn.
“Eating a healthy, well-balanced diet is key for any pregnant woman,” says Manju Monga, MD, the Berel Held Professor and the division director of maternal-fetal medicine at the University of Texas. If you have any questions or concerns about your diet or weight gain, talk to your obstetrician or a registered dietitian to get some pointers.
“We will develop an individualized plan that may include starting the day with a healthy breakfast, and avoiding foods that contain empty calories,” says Dana Greene, MS, RD, a nutritionist in Brookline, Mass., who routinely counsels pregnant women and those trying to lose weight after pregnancy. “For women with RA, I will also discuss foods that are rich in calcium because many of them may be taking medications that cause bone thinning.”
After pregnancy, exercising can help you lose weight and maintain that loss. But, it can be hard to find the time and energy to exercise when you have a newborn at home. And if you're having an RA flare, it can be doubly challenging.
“The most dramatic weight loss occurs in the first six weeks after delivery, and most women are not doing significant exercise during this time,” Monga says. When you get the all-clear from your obstetrician that it is OK to start exercising, you might want to start by walking, not running. “You want to avoid things that put force on knee joints and hip joints,” Monga says.
Although there's no specific link between RA and diet, some women may find that certain foods make them feel worse. “If there are any foods that tend to trigger a flare for you, avoid them during the postpartum period where a flare is considered more likely,” Greene says. “For some of my patients, this means avoiding red meat.”
If you have RA, you may have a higher risk of heart disease. Greene often helps women make heart-healthy food choices during pregnancy and afterward. “We discuss good fats that can raise levels of high density lipoprotein or 'good' cholesterol, fiber, and other foods that can really improve heart health and aid in weight loss,” Greene says. That means the kind of fats found in olive oil and canola oil, fish like salmon, and nuts like walnuts and almonds, as opposed to the kind found in fried and processed foods.
Proper nutrition for mom and baby during breastfeeding are also popular topics in Greene’s office. “This is especially important if women are taking steroids because the baby needs calcium too,” she says.
SOURCES:Shreyasee Amin, MD, rheumatologist, Mayo Clinic, Rochester, Minn.Amy Louise Nelson, Rochester, Minn.Manju Monga, MD, Berel Held Professor, division director of maternal-fetal medicine, University of Texas.Dana Greene, MS, RD, nutritionist, Brookline, Mass.
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