How Does Pregnancy Affect the Course of Rheumatoid Arthritis (RA)?

Last Editorial Review: 8/27/2020

Ask the Experts

I’m 23, and I just found out I’m going to be a mother for the first time! Getting pregnant wasn’t easy for me, though, because I have fertility problems from my rheumatoid arthritis.

I know I seem too young for RA, but it started after a fall where I broke my elbow, and I’ve had to control it with medication since.

I need to consult with my doctor to determine which medications are still safe and the specific risks my baby faces as a result of my rheumatoid arthritis, but can you please tell me what to watch out for, in general? How will pregnancy affect my RA?

Doctor’s Response

Congratulations on your pregnancy!

First, the bad news.

You may have to stop taking or drastically reduce the dosage of drugs you’re taking to control your RA pain.

NSAIDs, especially COX inhibitors like Celebrex, are contraindicated in all three trimesters of pregnancy.

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

RA drugs like corticosteroids, TNF Inhibitors, hydroxychloroquine and others used to control inflammation can be used with varying degrees of caution during pregnancy, depending on the drug, though they come with some risks for low fetal birth weight, cleft palate and other problems.

The JAK stat inhibitors (used to treat inflammatory disorders), baricitinib, tofacitinib, and upadacitinib, are to be strictly avoided.

Rituxan (rituximab) is to be avoided as well.

Please consult with your doctor, as the risks and benefits of RA medications during pregnancy, as they are different for every woman.

The good news?

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, however, such as those with severe disease.

Furthermore, delivery by cesarean section does not appear to be performed more commonly in patients with rheumatoid arthritis (RA). In some women with RA who have severe disease, the need for cesarean delivery may be higher than other women, however. Any pregnancy, independent of whether the mother has RA, may include factors that require a C-section for a safe delivery.

Here's more good news: Various factors that improve the symptoms of rheumatoid arthritis are also natural conditions of pregnancy. For example, pregnancy prompts

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

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

So, even though you probably have to dial down or change your dosage of RA and pain medications, you have a good chance your symptoms will improve as a result of your body’s natural changes.

Take warning, however; a smaller, but significant, percentage of women with RA experience a worsening of symptoms with the onset of pregnancy.

But most of the time, pregnant women with RA have healthy pregnancies and babies, provided adequate precautions have been taken. Good luck to you and your new life as a mother!


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