Rheumatoid arthritis and pregnancy: Disease activity, pregnancy outcomes, and treatment options during pregnancy and lactation

The present work reviews the available data on rheumatoid arthritis (RA) during pregnancy and the postpartum period. The data generally support some improvement in RA during pregnancy, but these data are not consistent, and a subgroup of patients may have significant disability and flares. The literature supports a tendency toward postpartum flares. Babies born to mothers with RA are found to have lower birth weight, intrauterine growth restriction, and an increased risk of delivery by cesarean section. Limited safety information is available for medications used for treatment during pregnancy and lactation. There are many options for treatment during the first trimester and throughout pregnancy, but each decision must be made on an individual basis. Whereas methotrexate and leflunomide are contraindicated in pregnancy, sulfasalazine is generally considered useful, as is hydroxychloroquine (despite the latter's FDA pregnancy category C rating). Of the biologics, the tumor necrosis factor (TNFi) are classified as category B; the other biologics vary between categories B and C, but more human data are available on TNFi. Drug Dev Res 72:689702, 2011. (C) 2011 Wiley Periodicals, Inc.