Q&A with Dr. Mark J. Pellegrino: Fibromyalgia and Pregnancy

August 31, 2005
National Fibromyalgia Association

Dr. Mark J. Pellegrino is one of the nation's leading experts on fibromyalgia. The author of numerous books and articles on fibromyalgia, he maintains an active medical practice in Ohio . He is board certified in physical medicine and rehabilitation and electrodiagnostic medicine, and was diagnosed with fibromyalgia 19 years ago, during his residency. Recently he took time to talk about pregnancy and FM with the National Fibromyalgia Association.

Q. What concerns do you hear from your patients who are considering becoming pregnant?

A: One of the top questions would be, "Having FM, should I have any concerns about getting pregnant? Will the newborn have FM?" And, "What will happen with me, the mom? Will I have to stop my medications?" The top concerns are about the baby, and what will happen to them.

Q: How do you respond to those concerns?

A: I tell people that fibromyalgia does have a hereditary and genetic component, and could be passed down. I just flat out tell them that's not a reason to not consider pregnancy.

A number of studies seem to support a genetic risk; they're finding that people can inherit a vulnerability of getting it. But fibromyalgia is not considered a medical risk to the fetus or newborn. It does not cause miscarriages. It does not cause infertility per se.

Fibromyalgia is common enough. It's not a life-threatening condition. Hopefully when the child is older there will be more effective treatments. And if the child does get FM, so what? That doesn't mean this person doesn't deserve to be in the world. That's not a reason to not have a child. They can still be productive, have a family of their own, have a wonderful life, and be a joy.

Q: And what about the mothers' concerns about their own health?

A: The potential for flaring up is there. But people that have had babies tell me they're very glad. The joy of bringing a child into the world far outweighs the pain of flares.

Q: What are the best ways to avoid a flare, or excessive pain and fatigue?

A: I recommend they continue doing stretching and conditioning exercises, especially back stretching and strengthening.

Q: How do patients deal with their medications during pregnancy?

A: They don't just stop medications altogether; some may need to be weaned away. But they may have to be off some of these medications before they attempt to become pregnant. There's no medication that's ever been reported to be completely safe during pregnancy.

Usually the first four to six weeks [of pregnancy] are the most vulnerable time. [Even if mothers unknowingly become pregnant and are still on medications during this vulnerable time], it's still a good idea to come off the medications. You want to give your baby the best chance to develop properly.

A lot of OB / GYN doctors don't have a problem with using Tylenol or other over-the-counter medications. The OB / GYN and the woman have to develop a comfort level [so they can decide together which medications can be continued].

Q: What types of medications are likely to be of concern to women hoping to conceive?

A: Anti-depressants and serotonin-type mediations. I recommend those be weaned.

I like to tell patients to get off pain medications too - wean off them. Even medications like Neurontin, Klonopin, and common medications used in fibromyalgia [should be weaned off].

Try to get off the herbal supplements and go on a prenatal vitamin. Hold off on the magnesium and malic acid until later in the pregnancy, or the pregnancy is over. I've never seen anything [stating that magnesium or malic acid can be detrimental to a fetus], but that's probably the best medical advice - ask them to get off it and start the prenatal vitamins right away.

Q: What can patients do to manage their symptoms while off medication?

A: Take advantage of natural medications. Use heat pads, ice pads, or prescribed massage. Sometimes I'll write a program prescribing massage and myofascial release. I suggest they do an exercise program including stretching and conditioning. Do Pilates, do yoga, get in the pool and do swimming and aquatics. I try to keep them active. But avoid skydiving, rock climbing, and deep scuba diving. [Laughs.]

Balance with rest and relaxation. Women in pregnancy need more rest, need more recovery time. They have to schedule time for themselves. And this isn't a bad idea the rest of the time! Keep in mind not only the physical, but the emotional well-being of the mom-to-be. Avoid smoke, alcohol, caffeine, and second-hand smoke.

Q: Is there any truth to the notion that some pregnant women experience a sort of "remission" of their FM symptoms?

A: That's one of the nice things you get tell people.

Most people, especially once you get through the first trimester, which can have morning sickness, nausea, and light-headedness - most people, even though off their medications, feel really well. The body's hormone changes [during pregnancy] are favorable to fibromyalgia.

Later in the pregnancy, sometimes women can start getting the mechanical changes, like strain on the back. Some can have sciatica if the baby is up against the sciatic nerve. The mother does become vulnerable to more pain and fatigue. A lot of fibromyalgia women report more muscle pain in the back, but not everybody has these muscle pains. Most women have a good six, seven months where they feel pretty good.

Q: Are there other changes women should be aware of?

A: Hormonal changes cause the ligaments to soften, to enable the birth canal to stretch easier in delivery. That can create more potential for pain.

The delivery can create more sacral iliac pain - low back and buttock pain.

Q: In your experience, how do women with fibromyalgia handle childbirth?

A: Most of the patients are choosing to have epidurals and have vaginal birth. Fibromyalgia is not an indication to have a C-section; most of them are having vaginal deliveries.

First thing after birth and recovery, moms need to continue taking care of themselves with physical programs. I like to get them back into their home program as quickly as possible.

Watch out for post-partum depression - though I don't find that women with fibromyalgia are more prone to that.

Nursing moms really have to watch the sleep-deprivation, because dads can't take a shift. You don't have anyone to help you out at night.

It takes us [people with FM] longer to recuperate. Don't get too concerned if it's four months later, and you're feeling like you're flared up.

Q: In your experience, does fibromyalgia affect women's decisions about family size?

A: I do not find my patients making their choices [about family size] strictly because of fibromyalgia. I think that answer may be surprising - but having a family, for many women, that's their goal in life. Especially if everything went well the first time, that offsets the pain of fibromyalgia.

It's the second child that's most likely to cause the flare-up. My theory is that pregnancy is a stress, like a trauma to the fibromyalgia body.

Things are out of sorts [during a first pregnancy], but before a bona fide flare-up could be established, things straightened out. 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 FM and for amplifying.

With the third one, things can get exacerbated, but they can be calmed down [too].

Q: Any concluding words?

A: Having some experience with other patients, I try to pass [their experiences] on. I try to help each person enjoy their baby as much as possible.

This article was reprinted with the permission of the National Fibromyalgia Association.