Some RA drugs are not safe to use during pregnancy or breastfeeding
Women with rheumatoid arthritis (RA) may worry about whether or not their condition will affect their ability to get pregnant—or to carry a healthy baby. But, those sufferers who want to become pregnant may be able do so if their disease is under control. With careful management by healthcare professionals, many women with RA have a healthy nine-month journey to motherhood.
That said, women with rheumatoid arthritis should be aware that their condition can bring with it some special pregnancy concerns—and potential complications.
It's important to talk to your doctor before trying to conceive. Together with your doctor, you'll want to tailor a treatment regimen that controls RA while posing little risk during pregnancy. Your doctor may recommend stopping certain medications, such as leflunomide, rituximab, methotrexate and abatacept, before trying to conceive to minimize risks to the developing fetus. Women with moderate to severe RA may want to seek care from both a rheumatologist and an obstetric team with experience in high-risk pregnancies.
The Effect of RA
It is largely held that RA itself is not a cause for avoiding pregnancy. But you should be aware of possible risks.
A Taiwanese study from 2009, for example, found that women with rheumatoid arthritis had twice the risk of preeclampsia than women without the condition, and that babies born to mothers with rheumatoid arthritis were more likely to be small for their gestational age and have low birth-weights.
Consulting with a rheumatologist prior to pregnancy and following proper prenatal care may help women with RA reduce their pregnancy risks.
RA Medications and Pregnancy
One of the most important issues affecting women with rheumatoid arthritis who become pregnant is medication. The following rheumatoid arthritis drugs carry with them the risk of miscarriage, birth defects or severe hemorrhage, or they have unknown effects that prompt experts to suggest avoidance during pregnancy:
- Cyclophosphamide (Cytoxan)
- Leflunomide (Arava)
- Methotrexate (Rheumatrex, Trexall)
- Mycophenolate (CellCept)
- Rituximab (Rituxan)
- TNF blockers, such as etanercept (Enbrel), infliximab (Remicade), or adalimumab (Humira)
- Warfarin (Coumadin)
To reduce the chances of complications, experts suggest using low doses of nonsteroidal anti-inflammatory drugs (NSAIDs) only up to the 32nd week of pregnancy. Similarly, lower doses of oral corticosteroids or sulfasalazine might be prescribed if needed. Researchers are continuing to study how RA drugs influence pregnancy outcomes.
How Will Pregnancy Change My Experience With RA?
Up to 16 percent of women have noticed that the symptoms of rheumatoid arthritis actually improve over the course of a pregnancy, especially in the second and third trimesters. Researchers aren't certain why this occurs, though it may be due to hormonal changes or increased levels of anti-inflammatory proteins called cytokines. More than a quarter of women, however, experience considerable disability.
Fatigue is common throughout pregnancy for women with rheumatoid arthritis, and can continue following delivery. This may be at a level that's more than you are used to. Many women with the condition are also more likely to deliver by Cesarean section, according to medical experts.
The symptoms of rheumatoid arthritis are likely to flare-up again, at least temporarily, in the weeks after a baby is born. This can be challenging to deal with, especially during recuperation and while adjusting to a new member of the family. Some women even find that it's difficult to hold their baby because of rheumatoid arthritis pain.
Talk with your doctor about medications that are relatively safe to use during this period, especially if you're breastfeeding—there are drugs can interfere with milk production, or are unsafe to be passed through breast milk to the baby.
American College of Rheumatology
The Arthritis Foundation
Lin, Herng-Ching et al. "Concise report: Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: a nationwide population-based study." Annals of Rheumatic Disease 2010;69:715-717 Published Online First: 29 April 2009.
Partlett R, Roussou E. "The treatment of rheumatoid arthritis during pregnancy." Rheumatology International. 2010 Dec 1.