Can Rheumatoid Arthritis Affect Pregnancy?

Reviewed on 8/17/2020

RA affects pregnancy in various ways
RA affects pregnancy in various ways

Yes, rheumatoid arthritis (RA) affects pregnancy. Most of the pregnant women with RA have low disease activity during pregnancy (60%) and may achieve remission by the third trimester as well. Few women may have worse or high disease activity. RA can lead to complications like preterm birth, raised blood pressure (preeclampsia), and low birth weight babies.

Overall, the women who have well-controlled RA have healthier pregnancies and newborns compared to women with active disease.

How does pregnancy affect rheumatoid arthritis?

Researchers state the various factors that improve the symptoms of rheumatoid arthritis in pregnancy:

  • Overall suppression of the immune system to prevent seeing the fetus as a foreign object
  • Hormonal changes that decrease disease activity during pregnancy
  • Increased level of anti-inflammatory substances in the blood that reduce inflammation and pain
  • Decreased levels of reaction causing proteins in the blood
  • Decreased white blood cell function during pregnancy

The overall suppression of the immune system and the release of anti-inflammatory decrease the RA activity in pregnant women. It also reduces inflammation and pain during pregnancy.

How will pregnancy affect my rheumatoid arthritis symptoms?

Approximately 60% of women experience improvement in rheumatoid arthritis symptoms throughout pregnancy. Around 20% of women can have their symptoms worsened during pregnancy. The exact mechanism for this variation is still being researched.

What effect does rheumatoid arthritis have on the baby?

RA may lead to low birth weight babies. Of the newborns, 3-5% may have birth defects. There are a few antirheumatic drugs that have the potential to cause birth defects. However, most of the time, pregnant women with RA have healthy pregnancies and babies provided adequate precautions have been taken. A few drugs may need to be discontinued well before conception. Consult with your doctor before you plan a baby.

What do pregnant women with rheumatoid arthritis need to know?

Women with rheumatoid arthritis should take special precaution during pregnancy:


What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis See Slideshow

Does rheumatoid arthritis increase the chance of pregnancy complications?

Women with poorly managed RA are at higher risk for early delivery (delivery before 37 weeks) and low birth weight babies. This can increase the possibility of health problems in the newborn. RA can also increase the probability of extremely high blood pressure and protein loss through urine (preeclampsia). Women with moderate to high disease activity have reported undergoing cesarean section delivery.

What antirheumatic drugs are safe during pregnancy?

Antirheumatic drugs that are safe to use during pregnancy are as follows:

  • Plaquenil (hydroxychloroquine): It is completely safe to take throughout pregnancy.
  • Infliximab/adalimumab: It can be used safely up to 20 weeks of pregnancy period. In exceptional cases, it can be used throughout pregnancy.
  • Enbrel (Etanercept): It can be continued up to 30 to 32 weeks of pregnancy period. If indicated, it can be used throughout pregnancy.
  • Certolizumab: It can be used continuously throughout the pregnancy. It is the safest among the TNF alpha inhibitor group of drugs.
  • Golimumab: It is preferred only in the first trimester.
  • Kineret (Anakinra): This drug is used to treat severe rheumatoid arthritis and prescribed when most of the options fail during pregnancy. Limited evidence suggests specific disorders in children born to mothers taking anakinra. The consumption in the first trimester is considered okay.
  • Orencia (abatacept): It is associated with definite facial and cranial abnormalities in a child. Abatacept should be considered only if the potential benefit justifies the potential risk to the fetus. Ideally, it should be discontinued 14 weeks before attempting to conceive.

NSAIDs, especially the Celebrex (COX inhibitors) are contraindicated in all three trimesters of pregnancy.

The JAK stat inhibitors, baricitinib, tofacitinib, and upadacitinib, are to be strictly avoided. Rituxan (rituximab) is to be avoided as well.

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