5 Warning Signs of Rheumatoid Arthritis
Do Women With Rheumatoid Arthritis Need to Stop Medicine While Pregnant?
Many, but not all, RA drugs are believed to be safe during pregnancy. Work closely with your doctor to keep the disease controlled.
By Meryl Davids Landau
Medically Reviewed by Alexa Meara, MD
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Becoming pregnant when you’ve been diagnosed with rheumatoid arthritis (RA) is a mixed bless for many women. Of course, you’re thrilled by the prospect of having a child. But you may also worry whether the medication you take to control your disease is safe for your baby.
In fact, as many as half of women with RA say they stopped taking their arthritis drugs during pregnancy, according to new research presented in September 2019 at the annual meeting of the American College of Rheumatology (ACR), which was carried out by the online patient community CreakyJoints. Many of these women suffer with troublesome arthritis activity during this time.
Considering Pregnancy? Consider a Preconception Appointment, Too
The fears about drug safety may be largely overblown. “People read about drug risks online, and they may seem bigger than their doctor knows it is,” says Benjamin Nowell, PhD, the director of patient-centered research at CreakyJoints.
This is one reason why it’s important to have a preconception visit with an obstetrician, ideally one who specializes in maternal-fetal medicine. Your doctor can discuss your medication with you, and also assess whether your disease is sufficiently under control for this to be a good time to conceive.
The Danger of Going Off Your RA Medication
In fact, there can be added risks to your pregnancy if disease activity is not well controlled. “People underappreciate the bad impact this can have on the baby, and the benefits that come with minimizing disease activity,” Nowell says.
One previous study of 152 women living with rheumatoid arthritis, for instance, found those with more active disease during pregnancy were at greater risk for delivering a baby with a low birth weight.
Is RA Medication Safe During Pregnancy?
A growing number of studies continue to show that many of the drugs prescribed for RA are safe for your unborn baby.
You can look up specific medicines on the reputable website Mother to Baby, which has information on the effects of common RA drugs on a pregnancy. You’ll want to avoid getting information from chat rooms and other sites not specifically vetted by experts.
RELATED: Rheumatoid Arthritis Drugs: Pros and Cons
3 Types of Drugs You Should Be Able to Take While Pregnant
The science supports the fact that the following drugs are generally safe to continue while pregnant:
1. Tumor Necrosis Factor Inhibitors (Anti-TNF) Also known as TNF inhibitors or TNF blockers, examples of this type of medication include Remicade (infliximab), Enbrel (etanercept), and Humira (adalimumab). These drugs are increasingly used during pregnancy because they have not been linked to birth defects.
In some cases, doctors suggest stopping treatment in the second or third trimester. But in another study presented in September 2019 at the annual meeting of the ACR, Canadian researchers looked at 61 women and found that the babies of those who took the drug throughout their pregnancy did not have added complications, while those who stopped the medicine were more likely to see their diseases flare before or after delivery.
Because of the potential effect on the immune system, an editorial published in February 2019 in the journalReumatologiasuggested that babies exposed to a TNF blocker during those later trimesters wait six months after birth before receiving any live vaccines. Infants whose mothers stopped taking the drug before 22 weeks can be vaccinated according to the normal schedules.
2. Oral SteroidsResearchers say it is safe to take oral steroids, such as prednisone, throughout your pregnancy. Scientists used to worry that babies could develop a cleft palate, but more recent studies have shown that isn’t true, according to a report published in August 2019 in the journalRheumatic Diseases Clinics.
Some studies do report that mothers on this drug may deliver prematurely, which was also found by another study presented in September 2019 at the ACR annual meeting. But experts believe this likely results more from the RA itself than from the medication.
3. Nonsteroidal Anti-Inflammtory drugs Also known as NSAIDs, this class of pain killers includes aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). These are commonly taken by pregnant women, according to results presented in September 2019 at the annual meeting of the ACR, from a study of more than 800 women performed by researchers at the University of California. These meds did not lead to preterm births or low weight babies.
NSAIDs are not typically recommended during the third trimester, for fear that this can prematurely close a vessel that runs from the pulmonary artery to the aorta. In the University of California study, some mothers who did take the drug in the last trimester had an increased risk of hypertension, or preeclampsia, but the researchers believe more research is needed to know if this is truly a reaction to the drug.
What About the Safety of Methotrexate?
Trexall (methotrexate) is a drug that should be avoided during pregnancy. Birth defects, including developmental delays and problems with the baby’s bones, have been linked to this medication. While use during the first trimester is the biggest concern, taking the drug later in the pregnancy has also been linked to problems in the baby, including learning difficulties.
If you do get pregnant while you’re taking methotrexate, talk to your doctor right away. But don’t panic, especially if you are on a lower dose. According to Mother to Baby, one study of 100 women with RA who were exposed to 5 to 25 milligrams of methotrexate per week in the first trimester did not have an increase in miscarriage or birth defects. Still, if possible, it’s best to stop taking the drug one to three months before you conceive.
Find the Right Physician or Specialist
Experts suggest that you should find an obstetrician who is familiar with the management of rheumatoid arthritis during pregnancy, which may be a maternal-fetal medicine specialist.
You’ll also want to consult your rheumatologist early in the pregnancy. Nowell says your rheumatologist will review all your medication with you and stay in consultation with the obstetrician throughout the pregnancy, so nothing falls through the cracks. In any event, you never want to stop taking any medication without consulting your physician.
Video: Advancing Treatment of Rheumatoid Arthritis Video – Brigham and Women’s Hospital
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