Rheumatoid Arthritis (RA) is a chronic, inflammatory autoimmune disorder that affects roughly 1% of pregnant women. RA can cause painful and swollen joints, fatigue, and body aches.

For many women with RA, the disease can be treated with medication to reduce inflammation and prevent damage to joints. However, many RA medications pose a risk to the developing fetus. Managing RA during pregnancy requires careful planning and communication between the patient, obstetrician, and rheumatologist.

RA Medications and Pregnancy

The following are the primary classes of medications used to treat RA:.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are used to relieve pain and reduce inflammation.

While most NSAIDs are classified as category C drugs during pregnancy (meaning that animal studies have shown adverse fetal effects, but there are no adequate studies in humans), the use of some NSAIDs, such as ibuprofen, in the third trimester can cause rare but serious complications, including premature closure of the ductus arteriosus and increased risk of bleeding. NSAIDs should be used with caution, and in the lowest possible dose, during pregnancy.

Corticosteroids

Corticosteroids are an effective treatment for RA, and are typically used in combination with disease-modifying antirheumatic drugs (DMARDs) and biologics.

Corticosteroids can pose a risk to the developing fetus, including increased risk of cleft palate and low birth weight. However, the risk is considered low when the medication is used in low doses for a short period of time.

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs are used to modify the course of RA and prevent joint damage. The use of DMARDs during pregnancy is generally not recommended, as many of these drugs have been associated with adverse fetal effects.

Methotrexate, for example, is classified as category X during pregnancy and is known to cause severe fetal abnormalities. However, some DMARDs, such as sulfasalazine, have been shown to be safe during pregnancy and may be used in certain cases.

Biologics

Biologics are a relatively new class of RA medication and are typically used in patients who have not responded to other forms of treatment. Biologics are monoclonal antibodies that target specific molecules in the immune system to reduce inflammation.

The safety of biologics during pregnancy is not well established, as little data exists on their use in pregnant women. Therefore, their use during pregnancy is generally not recommended.

RA Medication and Breastfeeding

The decision to breastfeed while taking RA medication requires careful consideration of both the risks and benefits.

Many RA medications can be passed to the infant through breast milk, and while some medications have been shown to be safe during lactation, others may pose a risk to the infant. Non-steroidal anti-inflammatory drugs, for example, are considered safe to use during breastfeeding, while methotrexate and biologics are generally not recommended.

Planning for Pregnancy with RA

Women with RA who are planning to become pregnant should work closely with their obstetrician and rheumatologist to develop a treatment plan that is both safe and effective.

In some cases, medications may need to be adjusted or even discontinued prior to conception. For example, women who are taking methotrexate should stop the medication at least three months before trying to conceive.

Women with RA who are pregnant should be carefully monitored throughout their pregnancy to detect and manage any potential complications.

The Bottom Line

While RA medication can be highly effective in managing symptoms and preventing joint damage, the potential risks to the developing fetus must be carefully considered.

Pregnant women with RA should work closely with their healthcare providers to develop a treatment plan that balances the risks and benefits of medication. By working together, women with RA can minimize the risks and achieve a successful pregnancy.