Rheumatoid Arthritis Medications and Pregnancyby Lene Andersen, MSW Patient Advocate
Whether you have rheumatoid arthritis (RA) or not, it’s important to protect your growing fetus from substances that can negatively affect its development. This is why pregnant women generally avoid for instance, salami, raw eggs, and cleaning their cat’s litter box. But what about RA medications?
Protecting your health
It’s commonly believed that if you’re pregnant, you shouldn’t take any medication at all because it may hurt the baby. But when you have RA, it may actually be better for both you and your baby to control your RA with medication. In fact, the American College of Rheumatology (ACR) recommends that as long as the medications you take for your RA are not harmful to the fetus, you should ideally remain on them to make sure your condition is under control.
Suppressing your RA while you’re pregnant continues to protect your body from the effects of RA, but may also protect your baby from the RA. Active RA can cause adverse pregnancy outcomes, such as low birth weight and premature birth.
In the past, steroids were considered the only safe medication to take during pregnancy, but new research shows that this is no longer the case. With the exception of certain RA meds (mentioned below), there are now many more choices for managing the condition during pregnancy.
Biologics are the latest addition to the collection of RA medications, having been on the market since approximately the year 2000. Initially, it was thought that pregnant women should avoid taking these medications, but more recent research indicates that continuing the anti-TNF biologics, such as Enbrel, Humira, and Remicade, will not just improve the mother’s health, but possibly also that of the baby. A Canadian study found that premature births were similar to that of the general population, low birth weight comparison showed no statistically significant outcomes and Apgar scores were actually slightly higher in babies whose mothers were on anti-TNF medication during pregnancy.
Although these types of medications are generally considered safe during pregnancy, some doctors feel that it’s best to discontinue them in the third trimester to reduce immunosuppressant effects on the baby. However, new research seems to indicate that babies exposed to immunosuppressants in utero do not appear to have an increased risk of infections.
Protecting the baby
Certain RA meds should also be avoided both during conception and the pregnancy itself.
Two RA medications are dangerous to a developing fetus: methotrexate and leflunomide (brand name Arava). Both of these medications can cause severe birth defects and it’s important to not get pregnant while taking these drugs. Doctors usually recommend that women stop taking methotrexate three months before trying to conceive, in order for the drugs to no longer be present in your body. Due to its effect on sperm cells, men, too, should stop taking this medication three months before trying for a baby.
Leflunomide stays in your body for much longer, up to two years. If you are taking this drug and want to become pregnant, it’s recommended that you complete a washout regimen to make sure the medication is completely out of your body. It is so toxic to a fetus that it is also recommended that men complete the washout regimen prior to the couple conceiving.
If you are sexually active and taking these medications, it is essential that you practice safe sex rigorously. It’s often recommended to “double up” on birth control, for instance, taking both the pill and using a condom or using both a diaphragm and a condom. Should you get pregnant while on these drugs, contact your doctor immediately.
What should you do?
Planning your pregnancy is a very good idea when you have RA. It is recommended that your RA has been well-controlled for three to six months before you try to conceive. As well, if you are on a medication that can damage the fetus, planning ahead is essential. So is involving your rheumatologist.
Even if you are not thinking of having a family now or in the near future, start having the discussion so your doctor can help you be in the best health possible, which may or may not include taking medication during pregnancy. Planning ahead will help make your experience of pregnancy and becoming a parent the best it can be.