Can Arthritis Drugs Harm A Fetus? What Every Pregnant Woman With Arthritis Should Know | Pregnancy articles | Family Health center

Arthritis is a condition that is characterized by joint inflammation, swelling and pain. Because it is chronic, there is no cure and it is life-long. However, there are lots of symptomatic treatments that can keep the condition under control and in check. One of the worries young women with arthritis will have is how the condition will affect the fetus if they get pregnant. The good news is that most arthritic women who become pregnant are able to have healthy pregnancies and deliveries with minimal risk to the mom or baby.

You should try to plan your pregnancy when your arthritis is well-controlled. Being pregnant can be very hard on the body, especially as you get larger during your pregnancy and add more pressure to the joints of your body such as hips and knees. Furthermore, if your arthritis is well-controlled then you are able to discontinue certain drugs or lower the dosage as it won’t affect you too badly.

There are some things, however, that every expecting arthritic mom should know about arthritis medications.

TNF-inhibitors are safe for use during pregnancy

Generally, patients with rheumatoid arthritis are prescribed a type of drug called disease-modifying antirheumatic drugs (DMARDs). While there are many DMARDs that are safe to use during pregnancy, there are some that are not.

One type of DMARD, TNF-inhibitors, are often used to treat rheumatoid arthritis. One study, which set out to evaluate pregnancy outcomes in patients taking TNF-inhibitors, found that there was a higher risk of miscarriage, preterm birth and babies born with lower weight than the general population of pregnant women. However, this is risk was not heightened when compared to women that have autoimmune diseases that are not under treatment with TNF inhibitors.

Therefore, many doctors believe that it is not TNF-inhibitors but instead the disease that leads to a higher rate of pregnancy complications. Furthermore, it is known that TNF inhibitors to do not go from the mother to the fetus and thus, there is no increased risk of birth defects. Hence, doctors recommend continuing use of TNF inhibitors during pregnancy.

The biologic drug certolizumab pegol, another anti-TNF drug, was also investigated regarding its ability to enter the fetus from the mother’s blood stream. Results indicated that there was very low transfer, thus making it safe for use during pregnancy. It also has low transfer from the mother to the baby through breast milk.

Anakinra may be continued if it is necessary to control your arthritis

Anakinra is a type of drug known as an interleukin-1 (IL-1) receptor antagonist that is used as a therapy for rheumatoid arthritis. It has not been studied significantly in the context of pregnancy but some animal studies have shown that it could have toxic effects during pregnancy. However, if you really need to keep your arthritis well-controlled then you should continue treatment.

JAK inhibitors are safe for pregnancy

Janus kinase (JAK) inhibitors are not very well studied in the context of pregnancy but are often prescribed for rheumatoid arthritis. Use of the JAK inhibitor tofacitinib was found to lead to similar results to the general population with regards to pregnancy outcomes. Therefore, while it can be prescribed to pregnant women, it is still best to monitor for any potential problems.

Rituximab should be discontinued if you are trying to get pregnant

Rituximab reduces inflammation, and therefore, is used commonly for treatment of autoimmune diseases. It suppresses the immune system, and therefore, can increase the risk of infection in the mother and the unborn baby. Therefore, it is best to stop taking rituximab a year before you start trying to get pregnant.

Leflunomide may lead to increased risk of birth defects

Leflunomide is another drug that is thought to likely increase the risk of getting birth defects. However, this has mainly been only seen in animal studies and has not been shown in human studies.

Some medications are associated with higher risk of birth defects

Some arthritis medications have been associated with a slightly higher rate of either birth defects or miscarriages. The list of these potentially harmful medication includes:

Chlorambucil (Leukeran)
Cyclophosphamide (Cytoxan)
Leflunomide (Arava)
Methotrexate (Rheumatrex)
Warfarin (Coumadin).

Methotrexate is especially toxic and should be stopped at least three months before you become pregnant because it has been associated with the development of birth defects. The good news is that there are other alternatives to these medications that can be taken during your pregnancy. You need to talk to your doctor to make sure that the drugs and the dosage of the drugs you are prescribed are safe for the fetus.

The safety of some medications depends on the stage of pregnancy

Some medications can safely be taken during some portions of your pregnancy, but they should be avoided laterto adjust either the dose or stop the medication altogether. For example, non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided later on in pregnancy. Another example is corticosteroids, the dose of which should be lowered during pregnancy.