Can Rheumatoid Arthritis Affect Pregnancy?

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.

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.

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.

Women with rheumatoid arthritis should take special precaution during pregnancy:

• Taking steroids may increase the risk of increased blood sugar and blood pressure levels. High blood pressure and high blood sugar can cause preeclampsia and gestational diabetes, respectively. These can be life-threatening and increase the risk for mothers and babies.
• Prednisone increases the risk of bone loss; hence, taking calcium and vitamin D is essential.
• Take mercury-free fish oil to fight inflammation.
• There might be an increased risk of gum disease in women with RA. Gum disease can increase the chance of preterm birth.

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.

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.