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

Last Editorial Review: 9/4/2020

Ask the Experts

I just found out I was pregnant after trying for two years! I have rheumatoid arthritis, so I had to undergo fertility treatments. But today was my first appointment with my OB/GYN, and she said everything looks healthy. 

I’ve had to dial back my medications, which left me deeply worried and bracing for a resumption of painful flares (I finally found the right drugs to control my symptoms a few years ago, and I only get a flare every couple months now, usually in response to stress.)

But I’ve been off my TNF inhibitor and have lowered my corticosteroid dose. I have been on this regimen for weeks now, and those dreaded flares never materialized.

I asked my rheumatologist about this and she told me that pregnant women often experience a remission of RA. It’s certainly a relief and my fingers are crossed that it lasts all nine months, but why does pregnancy affect RA?

Doctor’s Response

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, chances are, 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. For example, some RA medications may not be recommended if you decide to breastfeed.

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). 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, however.

Good luck to you and your new life as a mother!


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