RA Pharmacotherapies and Pregnancy

Methotrexate is the cornerstone of treatment in RA; however, it is a known teratogen and abortifacient with no definitive safe dosage in pregnant women.12  It should therefore be avoided during pregnancy. Sulfasalazine and hydroxychloroquine are the nonbiologic DMARDs of choice in pregnant patients with RA.12 The use of tumor necrosis factor (TNF) inhibitors and other biologic therapies in pregnant patients with RA is more controversial. 


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A 2009 review of the US Food and Drug Administration (FDA) database found a higher-than-normal amount of congenital anomalies that are part of a constellation of abnormalities—vertebral, anal, cardiac, tracheoesophageal, renal, and limb (VACTERL)—seen in children born to mothers taking a TNF antagonist.13

However, analyses of other studies have not found the rate of congenital malformations in the offspring of TNF inhibitor-exposed mothers to be different from the general population.14

NSAIDs are generally not used after 32 weeks of gestation due to their potential for causing premature closure of the ductus arteriosus.1  These agents are associated with an increased risk of miscarriage in early pregnancy, possibly by causing abnormal implantation of the embryo.1 Glucocorticoids such as prednisone and prednisolone are frequently used to treat disease flares. They should be maintained at the lowest dose possible and gradually weaned.1

A 2011 study by Dr Kuriya and associates found that glucocorticoids, received by >30% of women, comprised the largest number of RA therapies dispensed during the gestational period, and that they were used more frequently during pregnancy than before.15

This article originally appeared on Rheumatology Advisor