What is chronic fatigue syndrome during pregnancy?
Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a condition that as not well understood, and that can be confused with other conditions. Still, it is an official diagnosis listed in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10). To be diagnosed with CFS, you must feel very tired most of the time to the point that it interferes with your concentration and daily activities for at least six months. Additional symptoms include muscle weakness, joint pain, sore throat, fever, headache, and sleep disturbances. Distinguishing CFS from other medical conditions is difficult enough in non-pregnant people, but it becomes even harder during pregnancy since pregnancy also often entails symptoms such as fatigue, aching, sleep disturbances, and even headache, plus pregnancy can exacerbate various diseases that otherwise have been subclinical before you got pregnant.
How common is CFS during pregnancy?
CFS is present in less than 1 percent of people overall, but pregnancy is one of several stressful phenomena that can bring on symptoms of CFS, or exacerbate the condition.
How is CFS diagnosed during pregnancy?
In addition to symptoms that you report, such as extreme fatigue lasting for episodes up to 24 hours, muscle weakness, joint pain, sore throat, fever, headache, and sleep disturbances, your doctor will evaluate signs on the physical examination, such as presence of swollen lymph nodes in the neck or shoulder/armpit region. If there is a suspicion that you may have CFS, the next step is to rule out other conditions that could be confused with CFS. These conditions include multiple sclerosis (MS), heart disease, lung disease, numerous different types of anemia, long-lasting infectious diseases (cytomegalovirus [CMV], Epstein Barr virus [EBV]), endocrinological diseases, and psychiatric conditions, such as depressive disorders. Workup for such conditions includes a range of tests such as magnetic resonance imaging (MRI), chest x-ray (CXR), electrocardiography (ECG), echocardiography, numerous blood tests, and psychiatric testing. If the various tests for numerous conditions come out negative and if you have been suffering from CFS symptoms consistently for at least six months, then your doctor can diagnose you with CFS.
Does CFS cause problems during pregnancy?
The fatigue, headaches, sleep disturbances, and aches and pains exacerbate the discomfort that normally, pregnancy often brings, making it very difficult to function. Additionally, because the cause of CFS is not understood, and because there is no specific test for CFS, people who are suspected of having CFS are vulnerable to being manipulated into accepting unproven treatments offered by so-called alternative health professionals (sometimes called practitioners of natural medicine) who operate outside the realm of evidence-based medicine. Such treatments are often inappropriate and dangerous.
Does CFS cause problems for the baby?
Because CFS disrupts your sleep and makes you uncomfortable, the baby is at risk of indirect consequences of your condition, such as spontaneous abortion (miscarriage) due to stress.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the CFS
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat CFS during pregnancy?
Because CFS symptoms overlap with those of other conditions, and because the causes of CFS are not understood well, and because it is not even clear whether CFS is a disease independent of other conditions, patients may be given antidepressant medications. These may include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and citalopram. Of all of these, sertraline and citalopram are considered fairly safe for the fetus.
If testing suggests that you may be suffering from inflammation in the nervous system, you may be offered immunotherapy consisting of biologics, such as Rituximab and other drugs that end with mab.
Who should NOT stop taking medication for CFS during pregnancy?
All changes in medication need to be discussed with your doctors. Typically, the team managing your condition includes your obstetrician, a rheumatologist, possibly a neurologist, and possibly a psychiatrist.
What should I know about choosing a medication for my CFS during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my CFS when I am breastfeeding?
SSRI medications given to the mother are considered fairly safe for a nursing infant, as there is very little absorption into breastmilk. Data show that rituximab enters breastmilk, but in small quantities, so it is thought to be fairly safe, but should be used with caution in nursing mothers.
What alternative therapies besides medications can I use to treat my CFS during pregnancy?
Exercise therapy, consisting of physical activities that you increase in a gradual manner, can be helpful, as can cognitive-behavioral therapy.
What can I do for myself and my baby when I have CFS during pregnancy?
It is very important to follow the instructions of your physician.
Resources for CFS in pregnancy:
For more information about CFS during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:
- Mayo Clinic. Chronic Fatigue Syndrome.
- Cleveland Clinic. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
General information
It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.
For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.
It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.
If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.
If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.
Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.