INFO - s Hopkins on RA treatment during pregnancy

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s Hopkins Arthritis

Rheumatoid Arthritis

Treatment During Pregnancy

Rheumatoid arthritis therapy during pregnancy is complicated by the fact

that none of the drugs discussed above have been shown to be safe in

pregnant women with adequate, controlled studies. Although joint symptoms

frequently remit during pregnancy, this effect is not universal. Treatment

decisions require careful consideration of the risks and benefits to the

mother and fetus.

All DMARD therapy should be stopped in women planning to conceive and in

pregnant and lactating women. Evidence of the risks of these agents to the

fetus either exists or cannot be ruled out. Methotrexate, because of

evidence of potential teratogencity should be stopped in men and women

planning conception (see above).

Although safety has not been proven in controlled trials, no evidence exists

for risks to the fetus of low dose prednisone (less than 20mg daily) or of

NSAIDs used in the first two trimesters. If necessary, joint symptoms are

best managed with the lowest possible dose of prednisone. Potential

prednisone complications include worsening of maternal gestational diabetes,

hypertension and intrauterine growth retardation. NSAIDs should be avoided

in the third trimester because of the potential for premature closure of the

ductus, prolonged labor and peripartum hemorrhage. Although both NSAIDs and

prednisone are excreted in the breast milk, both are considered compatible

with breast-feeding by the American Academy of Pediatrics.

http://www.hopkins-arthritis.som.jhmi.edu/rheumatoid/rheum_treat.html

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org