Safest Rheumatoid Arthritis Drugs During Pregnancy

Reviewed on 8/17/2020

Which rheumatoid arthritis drugs are safe during pregnancy?

Safest RA drugs during pregnancy
Safest RA drugs during pregnancy

None of the drugs used in the treatment of rheumatoid arthritis (RA) is completely safe during pregnancy. You must discuss with your physician regarding the decision to use, modify, or stop any medications.

Pain control during pregnancy may be done through nonpharmacologic management such as paraffin baths, decreased physical activity, splinting, and cold packs as adjunctive care.

Corticosteroids: They are considered relatively safe in pregnancy when used in low doses and are designated as category B medications. Category B drugs are those which have found to be safe in pregnant animals although they lack adequate studies in pregnant women. Corticosteroids have potent anti-inflammatory action. They may, however, increase the maternal risk of high blood pressure, swelling, increased sugars during pregnancy, poor bone health in pregnancy, premature delivery, low birth weight babies, and birth defects such as cleft palate in the newborn. Certain corticosteroids such as prednisone and hydrocortisone are safer for use without adverse events in the fetus.

Sulfasalazine: It is another important medication for RA. It is also a category B medication. Sulfasalazine does not put the developing baby at risk and is considered safe in pregnancy.

Hydroxychloroquine or HCQ: HCQ is considered safe during pregnancy. It is a category C medication, which means that animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may permit the use of the drug in pregnant women.

Tumor necrosis factor (TNF)-alpha antagonists: These are commonly used in RA management. They belong to category B and are considered safe during pregnancy.

Certain other drugs such as azathioprine and abatacept are used in the treatment of RA in pregnant women only if the risks of side effects are outweighed by the benefits of these drugs. These drugs have found to cause fetal defects in a few studies.

Hence, the ultimate decision to use a certain drug should be made only in consultation with the doctor.

Can rheumatoid arthritis cause miscarriage?

Most studies on RA suggest that RA does not increase the overall risk for a miscarriage. Some researchers suggest that both disease activity and certain RA medications may have a role in causing miscarriage in some women such as those with severe disease.

Does having rheumatoid arthritis increase the chances of cesarean delivery?

Generally, delivery by cesarean delivery does not appear to be performed more commonly in patients with rheumatoid arthritis (RA). Any pregnancy, with or without RA, may be associated with factors that demand the baby to be delivered by cesarean delivery. None of the studies done so far conclusively say that RA mandates or increases the chance of cesarean delivery. In some women with RA, who have severe disease, the need for cesarean delivery may be higher than other women.

What should a pregnant woman with rheumatoid arthritis eat?

Because rheumatoid arthritis (RA) affects the joints, it is important to eat right during pregnancy. There should not be excess weight gain in pregnancy. At the same time, the mother and baby’s nutritional needs should not be compromised. Pregnant women with RA are advised to have a low-fat, high-carbohydrate, and high-fiber diet. This includes a diet rich in vegetables, fruits, nuts, mushrooms, and salmon. They should avoid fried and grilled foods, pastries, pasta, and other processed foods. They can have fish oils in moderate quantities during pregnancy only after consulting their doctor. Pregnant women with RA should avoid over-the-counter (OTC) herbal remedies and supplements. They should take routine oral calcium and vitamin D supplements as advised by their doctor.

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References
https://emedicine.medscape.com/article/335186-overview#a2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098768/

https://www.arthritis.org/health-wellness/healthy-living/family-relationships/family-planning/rheumatoid-arthritis-and-pregnancy

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