Chronic Fatigue Syndrome & Pregnancy/Breastfeeding
If I plan to become pregnant any time in the future, is the treatment safe to take while pregnant, and are there other risks in pregnancy? What about for breastfeeding?
Since the treatment for chronic fatigue syndrome varies from patient to patient, each case must be considered individually. For example, if you’re taking an amphetamine to improve your energy levels, you might want to consider tapering and discontinuing this medication prior to conceiving, and you should strongly consider discontinuing such agents once you discover you’re pregnant. Amphetamines are classified as Pregnancy Category C drugs, meaning they have caused fetal harm in animal studies. In addition, infants born to mothers who use amphetamines often suffer from severe withdrawal symptoms. Similarly, women who take antidepressants or painkillers to deal with chronic fatigue syndrome-related symptoms should check with their doctors before getting pregnant or breastfeeding, even though many of these drugs are considered safe during pregnancy and lactation.
Non-pharmacological treatment modalities, such as physical therapy, graded exercise programs, acupuncture, biofeedback, counseling, and behavioral therapy, can generally be continued during pregnancy and breastfeeding.
Will pregnancy increase my risks for onset of new autoimmune conditions that commonly occur with chronic fatigue syndrome?
By definition, chronic fatigue syndrome cannot coexist with an autoimmune disorder. The presence of any “active, unresolved or suspected disease that is likely to cause fatigue” (thus, any autoimmune disease) automatically rules out a diagnosis of chronic fatigue syndrome. As to whether pregnancy increases your risk for developing a new autoimmune disease, there’s no convincing evidence that this is the case. Even for women with pre-existing connective tissue disorders, pregnancy exerts variable effects. For example, some studies suggest that nearly 60% of lupus sufferers experience flares during pregnancy. In contrast, pregnancy actually improves symptoms in about 70% of women with rheumatoid arthritis.
Are there any studies addressing the onset of chronic fatigue syndrome during or just after pregnancy?
There’s a distinct paucity of hard scientific data regarding pregnancy’s effects on chronic fatigue syndrome (and vice versa). No studies directly address the risk for developing chronic fatigue syndrome during pregnancy or shortly thereafter, and only one trial, published in the February 2004 issue of Archives of Internal Medicine, examines the effects of pregnancy on preexisting chronic fatigue syndrome. While you might expect chronic fatigue syndrome to inevitably worsen during pregnancy, this study revealed no change in chronic fatigue symptoms in 29 (41%) of 70 women during pregnancy, an improvement of symptoms in 21 (30%), and a worsening of symptoms in 20 (29%). After pregnancy, there was no change in chronic fatigue symptoms in 30% of these subjects, improvement in 20%, and a worsening of symptoms in 50%. Interestingly, these findings mirror those seen in pregnant women with “classic” autoimmune diseases, supporting the notion that chronic fatigue syndrome will one day be classified as a true autoimmune illness.
Questions for your doctor
- Which of the medications I’m currently taking for chronic fatigue syndrome should be discontinued before I get pregnant, and how long should I wait to conceive after I stop taking them?
- Can I continue my current medications if I decide to breastfeed my baby? If not, what are my options?
- If my chronic fatigue syndrome worsens during pregnancy, what treatments can I try—both pharmacologic and non-pharmacologic—to help me until I deliver?
JP Buyon. The effects of pregnancy on autoimmune diseases. J Leuko Bio. 1998;63:281-287
RS Schacterle, AL Komaroff. A comparison of pregnancies that occur before and after the onset of chronic fatigue syndrome. Arch Int Med. 2004;164(4):401-404
About the Author
Steve Christensen, MD – “Doom” to his close friends – was trained at the University of Utah School of Medicine. Since his premature retirement from medicine in 2003, Dr. Christensen has expanded his knowledge of alternative medicine: he is a certified herbalist; he has dabbled at the edges of Ayurvedism, shared ideas with Chinese physicians, rubbed shoulders with Native American healers and contemplated the healing powers of channeled energy.
This blog post was originally published by AutoimmuneMom.com, written by Steve Christensen, MD, and first published on Jun 3, 2012.
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