Fibromyalgia and Pregnancy: A road of uncertainties

Growing a tiny human is overwhelming for any woman. Pregnancy comes with a series of uncertainties—finding prenatal care, preparing a stable home, and let’s not forget the responsibility of raising a child. Women with fibromyalgia take on even more stressors. To ensure the possibility of a healthy pregnancy, women with chronic pain conditions who are pregnant or who may become pregnant must be aware of the risks, symptoms, and management of fibromyalgia and pregnancy.

What is Fibromyalgia?

Fibromyalgia is a condition characterized by chronic, widespread musculoskeletal pain. The tenderness and pain range from a dull ache to sharp or stabbing, and migrates to specific locations known as “tender points” that are tender after applying pressure. People with fibromyalgia have heightened pain sensations. These flares of chronic pain are thought to be caused by changes in how the brain processes pain signals. It is non-inflammatory, meaning it does not damage effected bones, joints, or muscles over time. However, fibromyalgia frequently occurs alongside inflammatory conditions (i.e. rheumatoid arthritis, lupus, ankylosing spondylitis, etc.).

Symptoms of Fibromyalgia

Fibromyalgia impacts each individual differently. Still, most patients do share basic symptoms. Symptoms in other body systems tend to accompany the widespread musculoskeletal pain and tenderness. This includes the nervous system, gastrointestinal tract, and the bladder.  

• Fatigue
• Headaches
• Cognitive difficulties or “brain fog”—the inability to focus and pay attention
• Depression and anxiety
• Sleep disorders like restless leg syndrome and insomnia
• Irritable bowel syndrome
• Painful urination
• Altered menstrual cycles
• Numbness and tingling in the hands and feet

Pregnant women with fibromyalgia are prone to extra fatigue, muscle weakness, headaches, dizziness, nausea, frequent urination, constipation, and pain.

Does Fibromyalgia Affect the Chance of Becoming Pregnant?

There is little evidence that having fibromyalgia alone interferes with the chance of becoming pregnant. Fertility is only affected if the secondary thyroid disorders, nutritional deficiencies, and hormonal conditions are present too. Fortunately, reversing infertility is likely through treating hypothyroidism, supplementing the deficient vitamin(s), and beginning hormonal therapies. But for most, the main detriment to becoming pregnant is engaging in sexual activity less often due to painful symptoms.  

Can Pregnancy Cause Fibromyalgia?

Pregnancy does not typically cause fibromyalgia. However, pregnancy can trigger the symptoms of fibromyalgia to worsen. A study from the Archives of Rheumatology confirms that women with fibromyalgia experience higher levels of maternal stress, anxiety, and depression. Physical stress, combined with emotional stress, is known to exacerbate the widespread pain and other symptoms in fibromyalgia and pregnancy.

Fibromyalgia and Pregnancy: Risk Factors 

The majority of women with fibromyalgia birth healthy, full-term babies with no health complications. Few studies document otherwise. However, in the scant research available, fibromyalgia can potentially pose pregnancy risk factors. For example, a study featuring 112 women associates fibromyalgia with an increased chance of miscarriage, gestational diabetes, and an excess of amniotic fluid (the fluid that surrounds the baby in-utero) which may result in shortness of breath or pre-term labor. Babies born to women with fibromyalgia are also at risk of low-birth-weight because of intrauterine growth restriction that restricts the growth of the baby in the womb.

Fibromyalgia and Pregnancy: Pain

Estrogen and progesterone are just two of many rapidly fluctuating sex hormones that support the healthy growth of a fetus as pregnancy advances. These hormone changes can induce flares of fibromyalgia—specifically, the chronic pain, but also stiffness.

Although the effects are lesser in the first trimester, the body releases relaxin as part of the conglomeration of pregnancy hormones in the second and third trimesters. Relaxin is produced by the ovaries and softens the ligaments surrounding the pelvis to prepare the body for birth. As the tissues soften, it loosens the joints in the sacrum, hips, and pelvis, all painful areas already sensitive in those with fibromyalgia. So, the fact that most women experiencing increased pain during pregnancy is no surprise. Contrarily, symptoms ease with the release of relaxin in some cases. The relaxation of the tissues reduces the tension of the muscles strained from chronic pain.

Weight Gain

Weight gain is another aspect of pregnancy that increases the musculoskeletal pain in fibromyalgia. As women gain the necessary weight, the body is put under stress. Tender tissues are even more stimulated. Lower back pain from carrying the additional weight of the baby is a particularly problematic location because the spine attempts to compensate through lumbar lordosis, which is a posture where the spine curves inward. Muscles and other tissues are burdened to balance the posture leading to pain.

Fibromyalgia and Pregnancy: Cognitive Symptoms

Cognition involves the thinking processes the brain uses to acquire knowledge through thought, experiences, and the senses. The cognitive symptoms of fibromyalgia such as the inability to concentrate, poor memory, and mental slowness are debilitating in some patients. The fibromyalgia patients assessed in Frontiers in Psychology had poorer performance in all cognitive domains: processing speed, attention, visuospatial and verbal memory, planning, and mental flexibility. Pregnancy fatigue can worsen cognitive symptoms.

  Depression and Anxiety

According to the Anxiety and Depression Association of America, depression and anxiety affect approximately 20 percent of people with fibromyalgia. Both disorders are common cognitive symptoms of fibromyalgia. Depression is a mood disorder marked by feelings of sadness, apathy, loss of appetite, poor sleep, and a loss of interest in regular activities. Similarly, anxiety is the excessive worry out of proportion to a given situation.

The exact correlation between fibromyalgia and depression and anxiety is not entirely understood. Scientists hypothesize that fibromyalgia interferes with brain chemicals responsible for regulating mood or that chronic pain triggers the fight-or-flight mechanism of the autonomic nervous system. Pregnant women with fibromyalgia are more likely to experience an exacerbation of depression and/or anxiety due to fluctuating hormones, worries about giving birth and rearing a child, additional pain, and a lack of restful sleep.

Sleep Problems From Fibromyalgia and Pregnancy

Fibromyalgia is related to a number of sleep disorders. Along with widespread pain, sleep disturbances are key features of the diagnosis. The primary complaint as it pertains to sleep is insomnia—difficulty falling and staying asleep at night. Nearly 42 percent suffer from restless leg syndrome and other studies reveal obstructive sleep apnea in 50 percent of the participants. Needless to say, fibromyalgia patients experience restlessness, awake feeling unrefreshed, and do not enter stages of deep REM sleep in which the body rests and repairs cellular damage. Poor sleep lowers the pain threshold while contributing to psychological stress. The lack of refreshing sleep also furthers problems with memory and concentration. Whether sleep problems are caused by pain or if the pain causes poor sleep remains undetermined.

Pregnancy compounds the symptoms of fibromyalgia, like poor sleep and fatigue. Firstly, pregnancy flares musculoskeletal pain making it difficult to rest from the discomfort and the challenge of finding a comfortable sleeping position. The other symptoms of pregnancy like heartburn, frequent urination, and add to the discomfort. Next, fibromyalgia and pregnancy affect the sleep-wake-cycle because the hormonal fluctuations disrupt nighttime sleeping patterns.

Treating Fibromyalgia During Pregnancy

The treating physician mustn’t mistake fibromyalgia symptoms for the traditional effects of pregnancy, as this can impede the patient in receiving proper care. Implementing a treatment pain early in the pregnancy is optimal for pain relief. While treating fibromyalgia is tricky without the added factor of pregnancy, but management is attainable with the support of doctors, therapists, and supportive loved ones.

Are Medications Safe?

Fibromyalgia is treated with a variety of medications including antidepressants, over the counter pain relievers (i.e. NSAIDs, acetaminophen), prescription painkillers, anti-seizure drugs, and naturopathic supplements. Painkillers and antidepressants, the main medications to manage fibromyalgia, are usually contraindicated during pregnancy. Most physicians recommended women discontinue pharmaceutical treatments, but before starting or stopping any medication, consult with your doctor or pharmacist about which medications are least likely to negatively impact the fetus.  

Physical Activity For Fibromyalgia and Pregnancy

While it seems counterproductive to move aching, painful muscles, movement is essential for managing fibromyalgia and pregnancy. Exercise increases the circulation of blood and oxygen to the muscles, thereby relieving pain. A second pain-relieving mechanism stems from endorphins, a group of hormones that act on the body’s opioid receptors. Endorphins are released with physical activity and trigger emotions of euphoria. Cognitive symptoms such as anxiety, depression, “fibro fog,” and mood swings respond particularly well to exercise.

What Exercises Are Safe for Fibromyalgia and Pregnancy?

Experts suggest at least 30-minutes of low impact exercise multiple times per week. This consists of:

• Walking
• Cycling
• Swimming. An exercise routine in a pool is a low impact exercise because the buoyancy of the water assists movement and range-of-motion.
• Stretching. The Journal of Pain Research emphasizes the significance of stretching for chronic pain, especially during pregnancy. Stretching helps to avoid injury. Perform stretches that target areas most affected by the combination of fibromyalgia and pregnancy (i.e. lower back, hips).
• Yoga

Lifestyle Adjustments For Fibromyalgia and Pregnancy

Being that most medications are not safe during pregnancy, pregnant women with fibromyalgia rely on lifestyle adjustments for symptom management. Incorporating the following into a daily routine has proven effective for reducing widespread pain, improving sleep, and decreasing overall stress levels.

• Sleep. Fatigue is profound in fibromyalgia. If insomnia or pain prevents sleeping at night, take scheduled naps throughout the day to catch up on rest.
• Pacing. Do not overdo it during regular activities. 20-30 minute breaks boost energy and allow tense, painful muscles to rest. Accept help from friends and family to drive to appointments, prepare meals, or complete household chores when flaring.
• Diet. Avoid alcohol, processed foods, and foods with preservatives. Studies show plant-based foods with antioxidants eliminate free radicals (molecules associated with illness) promote fibromyalgia symptom management. Eat a balanced diet of fruits, vegetables, whole grains, healthy fats like avocado or olive oils, and anti-inflammatory spices.  
• Baths. Warm baths—not hot—relax tense muscles and lessens the pressure on tender point areas like the knees, hips, and back that are overworked from pregnancy.
• Mindfulness meditation. Mindfulness meditation is a behavioral technique that fosters awareness of the present, as well as bodily sensations, without judging perceptions as good or bad. To practice mindfulness meditation, find a secluded location. Focus on breathing and redirect wandering thoughts back to patterns of inhalation and exhalation.
• Massage therapy. Despite tender points, massages applying gentle pressure may reduce pain by encouraging healthy blood flow to the muscles. Massage is known to improve range of motion and increase the body’s production of natural pain killers.  
• Acupuncture. Acupuncture is derived from ancient Chinese medicine. Tiny needles inserted under the skin stimulates the nerves with connections to neurohormonal pathways. The nerve then transmits signals that cause the body to release hormones (endorphins) that reduce pain and boosts positive emotions.

Fibromyalgia and Pregnancy: The Birth

Fibromyalgia does not drastically impact the pain experienced during birth largely because of the epidural procedure administered to numb the sensations of labor. Special considerations during labor might entail positioning the back and legs comfortably to avoid an acute back injury. Techniques to reduce stress are helpful coping mechanisms to prevent the condition from flaring.

The contractions during labor interfere with lower back structures. Increased sensations of pain are felt after the delivery once medications have worn off. Muscles, tendons, and ligaments were stretched from pregnancy and after birth, the body is trying to reach a state of equilibrium without the baby in the womb. Muscle spasms and tenderness are common as the muscles compensate.

Postpartum Depression

Those with fibromyalgia are susceptible to clinical depression. Exacerbation of psychological symptoms is not unexpected, as hormonal fluctuations lead to post-partum depression in women without chronic pain condition. Postpartum depression is a mood disorder affecting women after childbirth. It causes feelings of extreme sadness, anxiety, mood swings, and exhaustion that originate from the drop in the hormones estrogen and progesterone after birth. If these symptoms are present prior to giving birth, pregnancy and delivery can intensify them.

References

Galvez-Sánchez, C. M., Reyes Del Paso, G. A., & Duschek, S. (2018). Cognitive Impairments in Fibromyalgia Syndrome: Associations With Positive and Negative Affect, Alexithymia, Pain Catastrophizing, and Self-Esteem. Frontiers in psychology, 9, 377. doi:10.3389/fpsyg.2018.00377

Genç, H., Atasever, M., Duyur Çakit, B., Seval, M., & Koç, A. (2017). The Effects of Fibromyalgia Syndrome on Physical Function and Psychological Status of Pregnant Females. Archives of rheumatology, 32(2), 129–140. doi:10.5606/ArchRheumatol.2017.6028

Tulay, K. T., Emrullah, T., Aydin, A., & Ciledag, O. F. (2016). The effect of fibromyalgia syndrome to gravidity, parity and duration of breastfeeding; A prospective study from Turkey. Pakistan journal of medical sciences, 32(3), 545–549. doi:10.12669/pjms.323.9574

Zamunér, A. R., Andrade, C. P., Arca, E. A., & Avila, M. A. (2019). Impact of water therapy on pain management in patients with fibromyalgia: current perspectives. Journal of pain research, 12, 1971–2007. doi:10.2147/JPR.S161494

Cheyanne Perry

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.