Rheumatoid Arthritis and Pregnancy: Should You Continue Drug Therapy?

Rheumatoid Arthritis and Pregnancy: Should You Continue Drug Therapy?

Numerous women of childbearing age may be apprehensive about conceiving after a rheumatoid arthritis diagnosis. The dangerous side effects from taking drugs is evident and the fear of taking drugs during pregnancy is more of a concern for the unborn fetus. Often, patients and doctors find it necessary to alter or modify RA treatment during pregnancy to decrease risks to the growing fetus.

rheumatoid arthritis and pregnancyThere is good news though, natural hormonal changes that occur during pregnancy actually enhance RA symptoms in many women. In other words, your rheumatoid arthritis symptoms can go into remission during pregnancy. An article archived in the Rheumatic Disease Clinics of North America journal Vol. 23 issue 1 states, Phillip S. Hench originally described the improvement of RA signs and symptoms during pregnancy in 1938, after a study was conducted of 22 women. He reported a 90% improvement in 18 of the women with RA.

Later studies validated Hench’s observations. Research on the effects of rheumatoid arthritis and pregnancy has demonstrated improvement in disease activity during gestation. Improvement occurs in approximately three fourths of pregnancies. Not all women improve, however between 70%-80% of women do experienced relief from symptoms and most improved during the first trimester.

Research has revealed when improvement from RA symptoms transpire, it usually continues throughout pregnancy and even 3-4 months postpartum. Studies have stipulated that if a woman improves during one pregnancy it is likely that enhancement will occur with subsequent pregnancies as well. The severity of rheumatoid arthritis does not determine if one will improve during pregnancy.

Although many women experience a decrease in disease activity during pregnancy some will still suffer with flare-ups and may need to continue drug treatment.

Case reports have shown recurrence of rheumatoid arthritis within 3-4 months post delivery.

Drug Therapy During Pregnancy

If you wish to conceive you should discuss your desire to become pregnant with your Rheumatologist prior to trying. Drug therapy during pregnancy and lactation is determined by you after consulting with your Rheumatologist and Obstetrician. It is necessary to discuss all benefits vs risks for the fetus and mother. Some physicians may suggest you stop taking drugs prior to pregnancy. Others may recommend tapering off or replacing your current medication with one that is less harmful once pregnancy has been confirmed. If you become pregnant unexpectantly immediately consult your doctor.

Drugs that should never be taken during pregnancy and should be withdrawn a minimum of 3 months prior to conceiving are:

  • methotrexate
  • cyclophosphamide
  • chlorambucil
  • leflunomide

There is an increased risk of fetal malformation or birth defects with the use of methotrexate and leflunomide.

Women who are being treated with leflunomide and become pregnant are recommended to be treated with a cholestyramine drug elimination procedure to reduce harmful exposure to the fetus.

Are NSAIDS safe during Pregnancy?

Drug Therapy During PregnancyNSAIDS are used for pain relief and inflammation. Except for the mild symptoms of nausea and vomiting which we are told can be alleviated by a small amount of food or milk, they are considered to be safe and effective by professionals and many users.

But, just how safe are NSAIDS? Most are familiar with these types of drugs, and they are widely used every year. It has been stated that long term use of NSAIDS cause toxicity to the stomach lining and kidneys.

Billions of over-the-counter NSAIDS are sold annually which include:

  • aspirin
  • ibuprofen (Advil)
  • naproxen (Aleve)

Millions of prescriptions are written for NSAIDS annually for arthritis patients. According to an FDA report 10,000 to 20,000 deaths take place each year due to the consumption of NSAIDS for arthritis.

There is reported evidence that exposure to NSAIDS (non-steroidal anti-inflammatory drugs) during pregnancy causes birth defects such as renal impairment, premature closure of the ductus arteriosus (a short vessel connecting the pulmonary artery to the aorta), gastrointestinal bleeding, intraventricular hemorrhage, and pulmonary hypertension. NSAIDS taken near conception weaken fertility by interfering with blastocyst implantation, resulting in spontaneous abortion.

Rheumatoid Arthritis and Pregnancy Outcome

Studies and reports have found no indications of adverse pregnancy outcome and rheumatoid arthritis. Case reports manifested no evidence of women with RA having infants with low birth weights, spontaneous abortions or premature infants.

Learn about healthy alternatives for conquering arthritis.

Wishing you an enjoyable and pain free life!

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