Rheumatoid Arthritis and Pregnancy Print Page
Overview
The body experiences many changes throughout pregnancy and not surprisingly, pregnancy affects the immune system and therefore may also affect your rheumatoid arthritis, an autoimmune mediated disease. Below we explore the interaction between pregnancy and rheumatoid arthrits.
How does pregnancy affect rheumatoid arthritis?
- Fortunately, up to 70% of patients will see improvement in their rheumatoid arthritis at the start of the second trimester of pregnancy without needing medications for their RA. However, many patients will experience a flare within 3 months of delivery.
How does RA affect pregnancy?
- Rheumatoid arthritis itself does not affect your ability to get pregnant, although some of the medications used to treat it do. RA does not increase risks to the fetus, although some babies may have lower birth weights.
How do I control RA symptoms during pregnancy?
- Because some medications for rheumatoid arthritis must be stopped during pregnancy, it is ideal to have your rheumatoid arthritis in good control before conception.
- Flare-ups can be safely treated during pregnancy as necessary, but most womens’ symptoms show significant improvement by their second trimester.
What can I do after delivery to control RA?
- Because most patients will flare within 3 months of delivery, many patients restart their RA medications after delivering baby. Keep in mind that many RA medications take weeks to start working.
- Some medications are not safe to use in breastfeeding; you will need to work with your rheumatologist to find safe alternatives if you plan on breastfeeding.
Which medications are safe to use in pregnancy?
- Remember: when considering what medications for RA to use during pregnancy, you must always weigh the balance between the risks to you and your baby of a medication and the risks of not treating your RA.
- Always discuss your treatment options with your rheumatologist
- The following medications are generally considered safe in pregnancy:
- Glucocorticoids less than 10 mg per day, and doses higher than 20 mg can be used but with caution. Concerns include cleft lip, premature membrane rupture, gestational diabetes, hypertension. Steroids differ in their ability to cross the placenta, with prednisone being safer in this regard. Low levels of glucocorticoids can be found in breastmilk.
- NSAIDs or anti-inflammatories (ibuprofen/Advil, naprosyn/Aleve, etc) are safe to use in pregnancy and do not cause any malformations up to 32 weeks of pregnancy. After 32 weeks, NSAIDs may cause premature closure of the ductus arteriosus (a blood vessel important in fetal circulation).
- NSAIDs may reduce your ability to conceive and should be discontinued if you and your partner are having difficulty with conception.
- Gold injections can affect your kidneys and blood counts whether or not you are pregnant, so appropriate monitoring is required. In pregnancy and breastfeeding, no specific risk to baby has been shown.
- Hydroxychloroquine is considered safe in pregnancy. While there is a theoretical risk to the development of the fetal eyes, it has not been observed in studies.
- Sulfasalazine is safe to use during pregnancy and breastfeeding. There may be a low risk of neural tube, oral cleft and cardiovascular defects. Sulfasalzine may cause a low sperm count in men.
- The following medications are all considered unsafe during pregnancy and breastfeeding and should be stopped at least 3 months prior to conception:
- Methotrexate
- Mycophenolate
- Cyclophosphamide
- Leflunomide – Stop 2 years prior to conception. A washout medication may be used to ensure leflunomide has been completely removed from the system.
- There are limited studies to state definitively whether biologics are safe in pregnancy, although there have been no clear problems identified yet.
It is always a good idea to discuss your treatment plan with your rheumatologist as you plan your pregnancy as one step to ensure a safe and successful pregnancy.
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