Gout

INFORMATION FOR WOMEN WHO HAVE GOUT DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is gout?

Gout is a type of inflammatory arthritis with painful swelling of the joints. In the case of gout, the swelling is most common in the extremities, the big toe being an especially common location. The condition comes from the presence of uric acid crystals, which are made during the normal metabolism of chemicals called purines. Uric acid crystals can accumulate to abnormally high levels due to problems excreting them from the body, or from having an excess of purines in the diet. Different people are more or less prone to gout based on their genetics. Gout can be chronic (present for many years with occasional flare-ups), in which case it usually shows up as painful nodules under yellowish areas of skin. Gout also can be acute, in which the person experiences sudden attacks of severe pain and swelling at the affected joints.

How common is gout during pregnancy?

Reports in the medical literature show the presence of gout in roughly 3 34 out of every 1,000 people. The condition is less common in younger women than in older women and men overall, but having gout in your family and having certain risk factors keeps the disease prevalent enough in both genders that it does coincide with pregnancy. Along with a family history of gout, factors increasing your risk of having the condition include diabetes, obesity, and metabolic syndrome, high blood pressure, hyperlipidemia (high levels of LDL cholesterol and triglycerides in your blood), use of aspirin and a group of medications called thiazide diuretics, and dietary factors. The latter includes foods that are high in purines, such as meat (red meat, poultry, fish), organ meat (liver, heart, sweetbread, gizzards), yeast extract, spinach, lentils, and beans (especially lima, soy, kidney, northern, white, and black-eyed beans).

How is gout diagnosed?

Doctors can gain a strong suspicion that you have gout based on your history and a physical examination showing characteristic features of gout joint inflammation, such as yellow skin and nodules under the skin in the affected joints. Affected joints also have a limited range of motion and can have red areas mixed in with the yellow, plus the joints can be warm. A typical symptom common in the history of a person with gout is that the pain is so severe during an attack that even feeling the bedsheets against the affected joint is painful. Patients also may have a fever. To make a definitive diagnosis, your doctor must draw fluid from the affected joint/s with a needle. The fluid is then examined under a polarizing microscope. The presence of negatively birefringent monosodium urate crystals, seen under the microscope, leads to a diagnosis of gout. Your doctor may also order x-ray images of the affected joints.

Does gout cause problems during pregnancy?

Gout can cause you extreme pain. Since it often affects the lower extremities and big toe, in particular, the pain can be accompanied by disability difficulty walking which pregnancy can exacerbate as your abdomen grows and your weight increases. The hormonal changes and increased weight associated with pregnancy can cause you to accumulate more uric acid, which can lead to more crystals in your joints and an increase in the number and severity of gout attacks. There is also some evidence that elevated uric acid in the first trimester can increase your risk of developing a severe pregnancy complication, called preeclampsia, later in the pregnancy.

Does gout during pregnancy cause problems for the baby?

Elevated uric acid levels during the first trimester may increase the risk of developing preeclampsia, a complication of pregnancy characterized by high blood pressure and problems with an organ, usually, the kidneys, which shows up as protein in the urine. Preeclampsia can cause premature birth, restricted blood flow, and abruptio placentae (detachment of the placenta from the uterus), which in turn can lead to fetal death, stillbirth, or death soon after birth.

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 gout
  • 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 gout during pregnancy?

Medications that are given to counter an acute gout attack consist of non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase 2 (COX2) inhibitors, colchicine, and corticosteroids. Drugs for long-term treatment and to control uric acid levels include colchicine, allopurinol, febuxostat, and probenecid. For many of the drugs, there is not enough evidence from studies to conclude that they are entirely safe for the baby. NSAIDs, for instance, have some known risks. These include drugs that you may know well, such as ibuprofen and many others. There is some concern that NSAIDs given frequently in high doses early in pregnancy can cause spontaneous abortion (miscarriage) and possibly birth defects. Furthermore, and more definitely, NSAIDs given in late pregnancy (after 30 weeks gestation) may cause a heart condition in the developing baby known as patent ductus arteriosus (PDA). Newborns with PDA are short of breath, ranging from mild to very severe. On the other hand, corticosteroids, which include prednisone and prednisolone are generally safe during pregnancy. Allopurinol has generally been considered safe during pregnancy, but in recent years caution has been advised for its use during the first trimester.

Who should NOT stop taking medication for gout during pregnancy?

This is a dilemma both for the pregnant patient and her doctors. Every drug used in gout has benefits and risks. However, since there are so many drugs, often it is possible to replace a less safe drug with one that is safer for the developing baby. Planning your pregnancy can make things much easier, both for you and your doctors.

What should I know about choosing a medication for my gout during pregnancy?

You may find Pregistrys expert reports about the individual medications used to treat gout here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my gout when I am breastfeeding?

The drugs that are effective against gout vary both in their tendency to enter breastmilk and in their potential to harm the nursing baby if they do get into the milk. In order to encourage breastfeeding, doctors have taken seriously the pharmacokinetics of various agents, meaning the science of how quickly the drugs move through the mothers system. For certain drugs, this has led to ideas on how to burn the candle at both ends in a sense. With the corticosteroid prednisolone, for instance, it is kn
own that it builds up in breastmilk mostly during the first four hours after a dose is given. Consequently, some doctors who give this agent for rheumatologic disease flare-ups will suggest that the patient wait four hours after receiving each dose, then pump out her milk and discard it, then wait for new milk to accumulate and nurse the infant from that new milk.

Some options for what to do about that missed feeding include: pumping earlier in the day and saving the milk to feed in place of the discarded milk, feeding formula for that one meal a day, or simply using formula for all feedings. A lactation consultant can help you if you would like to keep breastfeeding. It is true that many studies suggest that there are benefits to breastfeeding both to the child and the mother, its also true that in most such studies it has been difficult to separate the true benefits of breastfeeding from various socioeconomic factors that also relate to whether women chose breastfeeding over formula.

What alternative therapies besides medications can I use to treat my gout during pregnancy?

There are dietary options that can reduce the severity of gout and sometimes help to prevent attacks. These include reducing or eliminating alcohol intake and reducing the intake of the sugar fructose. This sugar is present in all fruits, but fruits particularly high in fructose include apples, cherries, mangoes, pears, and watermelon. You can substitute lower-fructose fruits and berries (and their juices), which include blueberries, bananas, honeydew and cantaloupe melon, strawberries and oranges. You may have heard that you should avoid something called high-fructose corn syrup [HFCS], but often avoiding foods with this ingredient on the box ironically leads people to consume more fructose. This is because there are different types of HFCS and the most common type used in sweetened drinks, called HFCS-42, actually supplies less fructose than what is usually used as a substitute for HFCS in foods that boast of containing no HFCS, namely cane sugar. Whereas HFCS is 42 percent fructose, cane sugar is 50 percent fructose. To avoid being misled, a prudent option is simply keep your consumption of sweets, including juices, at a minimum. Low purine diets have been proposed, but are not very practical, especially when you are pregnant and therefore need to consume a good amount of protein. One other non-medication approach to gout is called joint aspiration, in which a needle is used to remove fluid from the affected joints.

What can I do for myself and my baby when I have gout during pregnancy?

Cooperate with your doctor to optimize treatment in order to minimize your symptoms, so you can focus on your pregnancy.

Resources for gout in pregnancy:

For more information about gout during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

 

Read the whole report
Last Updated: 30-01-2020
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.