Rheumatoid Arthritis during Pregnancy

Reviewed by James Brann, MD
A woman with rheumatoid arthritis, or RA, can have a healthy pregnancy. However, you’ll need to work with your doctors. They’ll want to make sure you’re doing the correct things to control symptoms and protect your unborn child.

Before getting pregnant

Before you try to get pregnant, you need to talk to your doctor. You’ll see an obstetrician for your pregnancy, a rheumatologist for your RA, and see your primary care physician. Together, they’ll make sure all of your medicines during pregnancy are safe. They may also want to test to make sure your body is prepared for pregnancy.

Some RA medicines could lead to serious problems for your baby. You want to stop taking certain things before getting pregnant, including:
  • Leflunomide (brand name is Arava) - You’ll want to stop taking this a minimum of two years before trying to get pregnant. Your doctor can also give you a different medicine to help rid your body of this medicine. Then, they’ll test to make sure the medicine is out of your system before you can try and get pregnant.
  • Methotrexate (brand name Trexall or Rheumatrex) - You’ll want to stop taking this 1-3 months before attempting to get pregnant. This medicine is dangerous for a baby.
If you get pregnant taking either of these medicines, let your doctors know immediately. Your physicians will then help you either stop or switch any medicines you’re on. They may also want to add some treatment.

Effect on pregnancy and baby

RA normally won’t lead to pregnancy problems or problems with your child’s health. However, some medicines used in the treatment of RA may not be safe for a baby.

Certain RA medicines may injure an unborn child. You don’t want to use any of these during pregnancy:
  • Leflunomide may lead your child to develop incorrectly
  • Methotrexate may lead to miscarriage (an end in pregnancy before week 20) or incorrect development with your baby.
  • Large amounts of steroids in the early part of your pregnancy may elevate the risk of cleft palate, a birth defect. In this case, the roof of your child’s mouth doesn’t form the correct way. A large amount of steroids in late pregnancy may also lead to the mom’s water breaking too early.


You need to talk to all of your doctors about each medicine you’re taking, and make sure you follow your doctors’ directions. Don’t begin taking new medicines, herbal drugs or supplements without asking your doctors ahead of time.
While some RA medicines may be taken during your pregnancy, it can only be in certain amounts and at certain times.

  • Steroids - Medicines like prednisone are pretty safe in small doses during a pregnancy. They’re often used on a pregnant woman who has RA to control the disease. These are the same types of steroids an athlete uses to build muscle.
  • NSAIDs - Medicines like ibuprofen (Motrin or Advil), aspirin and naproxen (Aleve) are included. You can used these medicines safely in pregnancy sometimes, but not at all times.


There are some safe medicines. Your doctors will be able to help you treat your symptoms of RA without injuring your child.

Pregnancy and symptoms

Your pregnancy could affect your symptoms of rheumatoid arthritis. For some women, the symptoms improve, but in other cases, the symptoms get worse or even stay the same.

Similarities between RA symptoms and pregnancy symptoms:
  • Pain of the joints
  • Breathing trouble
  • Ankle, feet and hand swelling
  • Tiredness
  • Pain or numbness in hands


If your RA symptoms do improve during pregnancy, they can still worsen after delivery. It’s up to your doctor when you start your RA medicines up again.

Breastfeeding

Women with RA can still breastfeed safely. You will have to avoid taking certain medicines during this time, though. Some could get into the breast milk and injure your child.

If you do want to breastfeed, make sure you talk to your doctors. They’ll be able to let you know which ones are safe, and which ones you should avoid. Most unsafe medicines during pregnancy are likely unsafe during breastfeeding, too. Some women may find that they have to stop breastfeeding to allow the medicines to control RA.


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