Family Planning with a Chronic Health Condition

Erica Lemons knew her path to motherhood wasn’t going to be easy. But she wasn’t going to let her chronic health condition stop her from getting pregnant.

“My doctor told me to talk to him before I got pregnant because of possible complications, so that’s the first thing I did,” she said.

Lemons quickly learned that trying to get pregnant with a chronic disease was going to be even more complicated than she thought. For starters, she had to stop taking the medicines she was on for her chronic illness and had to wait months before she could get pregnant.

“I was shocked — I didn’t realize how long I had to be off the medicines before I could even try,” she said. “My advice for anyone thinking about getting pregnant is to talk to your doctor sooner than later. You may have to wait longer than you think.”

Nearly 3 out of 10 women and people assigned female at birth in the U.S. are living with multiple chronic conditions. These conditions usually require medicine, which is why it’s important to talk about family planning with your healthcare provider (HCP), even if it’s just a possibility for the future. Your HCP may be prescribing more aggressive treatments that may not be the best option if you’re considering pregnancy in the future.

Unfortunately, not all HCPs are asking about pregnancy planning. This may be because of many factors, including a lack of time, knowledge and skills to start the conversation. In one review of pregnancy planning and women living with chronic conditions, the women said their health information needs were not being met. And they wanted to have better discussions with their HCPs.

​What is shared decision-making?

Shared decision-making is when you decide on your treatment path after a thorough conversation with your HCP. This is especially important for people with chronic health conditions who are planning a family.

HCPs manage your health before, during and after pregnancy and provide guidance that may influence family planning. “Some diseases worsen during pregnancy and some improve, and knowing this would help you determine a good time to start trying to become pregnant,” said Connie Newman, M.D., adjunct professor of medicine at NYU Grossman School of Medicine and a member of HealthyWomen’s Women’s Health Advisory Council.

Chronic health conditions last more than a year and can include a wide range of diseases from multiple sclerosis (MS) to diabetes to high blood pressure. Both the condition and the medicine can affect pregnancy and your ability to get pregnant in the first place. Some medicines can cause serious problems during pregnancy, such as preterm birth and birth defects.

Read: Can Living in the U.S. Increase Your Risk of Preterm Birth? >>

“Patients should tell their HCP about their plans for pregnancy and ask the HCP whether the prescribed treatment is safe during pregnancy. If the answer is no, then the patient can ask about taking a different medication that is safe to use,” Newman said. “Patients should also ask whether the disease will worsen during pregnancy, and how their medications should be adjusted.” Changes may include the dose, how many times you take it and/or a different medicine altogether.

​Questions to ask your healthcare provider about chronic disease and pregnancy

If you haven’t talked to your HCP about your plans, you may want to schedule a preconception counseling visit. During the appointment, your HCP will review your treatment plan and how pregnancy may affect your health overall.

Newman said it’s a good idea to write down questions you have about pregnancy and bring them with you to your appointment. These can include:

Will my disease get worse during pregnancy or improve? And when will this happen (first, second or third trimester)?
Will the medicine I’m taking be harmful during pregnancy, including very early pregnancy before I may even know I’m pregnant?
Can you describe the risks of the medicine?
Will I have to stop the medicine or switch to a different medicine when I’m pregnant? Should I do this when trying to get pregnant or after the pregnancy test is positive and I know for sure I’m pregnant?
Can I breastfeed while taking this medicine?

You can also talk with your HCP during your well visit if you haven’t already done so.

​Weighing risks and benefits of treatment options

Weighing the risks and benefits of treatment are a crucial part of the shared decision-making process. “The HCP and the patient should discuss the risks and benefits to determine a plan for medication use during pregnancy,” Newman said.

Outside of talking with your HCP, Newman said women can read about potential effects of treatment options using reputable online sources, including the patient information part of the drug label or the drug labels written for prescribers.

Managing chronic conditions can also mean involving specialists and other HCPs in your family planning process. Lemons said her HCP connected her with a fertility specialist, for example, and other HCPs along the way. She said she appreciated all the frank conversations they had and that his support meant so much during a time when she felt so overwhelmed.

Lemons gave birth to a healthy baby boy in 2012. She said all the planning and waiting and anxiety wasn’t easy. But nothing is exactly easy when you’re pregnant and managing a chronic condition. “Just remember to be kind to yourself and your mental health,” she said. “Put yourself first.”

This educational resource was created with support from Viatris, a HealthyWomen Corporate Advisory Council member.