ABU DHABI // Muna realised that all was not well when she became pregnant for the first time.
The 37-year-old Emirati has been suffering from rheumatoid arthritis for many years.
“I discovered I had rheumatoid arthritis in 1997 and then it got better after I took several types of medicine,” she said, adding that the chronic disease had been largely under control since 2004.
During her pregnancy Muna developed fibroids – non-cancerous growths in her womb – that caused her to lose her first child at 22 weeks.
She says the UAE needs special medical centres to care for pregnant women with auto-immune disorders such as hers, which causes inflammation of the joints.
“One of my friends has rheumatoid arthritis and she is worried about getting pregnant,” Muna says.
An auto-immune disorder develops when the immune system attacks and destroys healthy body tissue by mistake.
“I think it would be helpful to have special centres because those who have rheumatoid arthritis don’t know the effect of the disease. These centres can deal with their specific requirements,” Muna says.
Rheumatoid arthritis and systemic lupus erythematosus (also an autoimmune disease) are the most common rheumatic diseases among pregnant women in the UAE, experts say.
They usually affect women in their childbearing years. Poor management of these diseases could lead to serious complications for the mother and the baby.
Dr Gowri Ramanathan, head of obstetrics and gynaecology at Danat Al Emarat, says all her patients with rheumatoid arthritis had been Emiratis.
“There are genetic and environmental factors. According to research, some genes have been identified with this disorder and exposure to dust, fibres, bacterial and viral infections can also be a cause,” she says.
“Medication used for rheumatoid arthritis needs to be reviewed prior to a woman getting pregnant. The doctor might try to wean the patient off certain medicine that might cause an abnormality in the developing embryo.”
Dr Gowri Ramanathan says such pregnancies are categorised as high-risk and need management throughout the gestation period. She sees her patients once every four weeks or once every two weeks in some cases.
“The medication for an auto-immune disorder has an impact on the development and growth of the foetus,” Dr Ramanathan said.
Medicine for auto-immune disorders shut down the immune system to keep the disease from flaring up.
“Some women who have a disorder stop all medication when getting pregnant. This is the wrong thing to do, as their disease can flare up,” says Dr Ramanathan.
“There is no comprehensive programme in the country to manage auto-immune disorders and there is no information on medical disorders in pregnancy. Also, very few places have the ability to manage the disorders in a combined way.”
Dr Bhavna Khan, a consultant rheumatologist at Mediclinic City Hospital in Dubai, says the UAE urgently needs to set up specialist pregnancy clinics for mothers to be with rheumatic conditions.
She says such clinics could collect medical statistics in the Middle East to help the authorities better understand where to expand medical services and improve them.
Happily for Muna, she gave birth to a healthy boy 11 weeks ago by carefully managing her rheumatoid arthritis during her second try at motherhood.