Rheumatoid arthritis medications: Dangerous during pregnancy?

Some rheumatoid arthritis medications may harm your unborn child. Which should you avoid during pregnancy?

By Mayo Clinic Staff

Many types of rheumatoid arthritis medications can harm your developing child during pregnancy. Talk to your doctor before you become pregnant, because it's best to avoid certain rheumatoid arthritis medications for several months before conception.

Rheumatoid arthritis occurs when your body's immune system mistakenly begins to attack the tissues around your joints. Many rheumatoid arthritis medications work by suppressing your immune system. Other commonly prescribed drugs control inflammation.

Different types of drugs carry different risks. Some can produce birth defects, while others can cause miscarriage. Some drugs used for rheumatoid arthritis can increase the risk of high blood pressure or diabetes for pregnant women.

The timing of when the drugs are taken within the pregnancy also can be important. For example, some medications may cause problems only in the third trimester, while others should be avoided completely.

Rheumatoid arthritis medications to avoid during pregnancy and breast-feeding include:

  • Methotrexate (Trexall). One of the most commonly used medications to treat rheumatoid arthritis, methotrexate can induce miscarriage early in pregnancy. Taken later in pregnancy, it can cause birth defects affecting the brain and bones.
  • Leflunomide (Arava). Doctors recommend avoiding this drug even before conception because it can remain in the body for a long time. Taking cholestyramine (Prevalite) can help speed the elimination of leflunomide from your body.
  • Biologic response modifiers. Because there is limited information about the safety of this class of drugs during pregnancy, doctors typically recommend avoidance if you're planning to conceive. Examples include anakinra (Kineret), rituximab (Rituxin), abatacept (Orencia), tocilizumab (Actemra) and tofacitinib (Xeljanz).

It's important for women who are taking these types of medications to use contraception. If you're planning to become pregnant, talk to your doctor about switching to different types of rheumatoid arthritis medications that are considered relatively safe to use during pregnancy.

A tumor necrosis factor (TNF) inhibitor, such as infliximab (Remicade) and adalimumab (Humira), might be an option, Some studies suggest that pregnant women with rheumatoid arthritis who take TNF inhibitors have similar rates of prematurity, miscarriage and birth defects as do women with rheumatoid arthritis who don't use these medications. One such drug, certolizumab pegol (Cimzia), doesn't cross the placenta.

More studies are needed to assess the safety of these medications during pregnancy.

April 20, 2017