Are Corticosteroids Safe for Pregnant and Nursing Women with Rheumatoid Arthritis?

Ask the Experts

I have rheumatoid arthritis, and recently found out I will have a baby in December! My partner and I were thrilled, as we have had problems conceiving because of RA-induced fertility problems. My baby seems healthy according to all the imaging and tests so far, and I am reading up on the right foods to eat with RA and which supplements to take so I can best protect my little peanut as he or she develops (we don’t find out the sex until next month).

One aspect seems odd to me: My doctor told me to keep taking the corticosteroids (prednisone) I’m prescribed to control my RA symptoms and flares. 

Corticosteroids are really powerful, and I know people who have had bad side effects like weight gain, nausea, and insomnia, among others. I’ve always been fine with my current prednisone dose, but aren’t corticosteroids dangerous for my baby if I take them while I’m pregnant?

What about when I start breastfeeding? Do corticosteroids pass to the baby in breast milk? Will I have to bottle feed if I can’t stop taking my RA drugs?

Doctor’s Response

Corticosteroids are considered relatively safe in pregnancy when used in low doses. Not all RA drugs are safe to use while breastfeeding, but low doses of prednisone should be OK. Even higher doses may be fine, as long as you pump and discard the milk you produce right after taking them.

Of course, every woman is different, and you should discuss the specifics of your case with your own doctor.

Corticosteroids like prednisone are category B drugs, meaning they have been found to be safe in pregnant animals, but lack adequate studies in pregnant women to make a blanket pregnancy safety determination. 

Corticosteroids have potent anti-inflammatory action. They may, however, increase the maternal risk of 

Certain corticosteroids such as prednisone and hydrocortisone are safer for use without adverse events in the fetus.

Is prednisone safe to take while breastfeeding?

Some RA medications are excreted in breast milk, but their quantities differ. 

You can still breastfeed on certain RA medications, however. A good strategy is to pump your milk just before they take your medications so that the amount of drug in the milk is negligible. 

Concerning the breastfeeding safety of the common RA corticosteroid prednisone, specifically: 

  • Nursing mothers taking prednisone in low doses (20 mg/day) are generally considered safe to breastfeed
  • At higher doses, women should pump and discard breast milk that is produced during the first four hours after taking the tablet.

There are several other non-steroidal medications prescribed for rheumatoid arthritis that are considered safe for breastfeeding women. These include the following:

Tumor necrosis factor (TNF) inhibitors such as etanercept, infliximab or adalimumab have limited safety data and should be avoided wherever possible.

Certain drugs used for RA are generally avoided during breastfeeding. Some of these include the following:

Reports suggest that certain drugs such as Rituxan (rituximab), Kineret (anakinra), and Orencia (abatacept) have shown no adverse effects on the baby during breastfeeding. However, there is a lack of long-term safety data, and doctors prescribe these drugs with caution. Hence, only the doctor can decide the most appropriate drug for a breastfeeding woman with RA.

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Reviewed on 8/27/2020
References
Rheumatoid arthritis and pregnancy


Raising a Baby When You Have RA


Rheumatoid Arthritis and Pregnancy