Update of the management of rheumatoid arthritis in pregnancy

Abstract

As the maternal age increases, and with the emergence of more effective therapies, clinicians are seeing more women with rheumatoid arthritis (RA) contemplating pregnancy. Newer evidence shows that RA remains active in pregnancy; active RA correlates well with adverse obstetric outcomes. Preeclampsia is common, as are operative and preterm deliveries in women with RA. Women with active RA are also more likely to have babies of lower birthweight. This article discusses the latest findings on population-based studies of women with RA and the various drugs used to manage RA. Controversies regarding biological agents are addressed, and guidance on prepregnancy counseling, antenatal care, delivery and breastfeeding based on our experience are detailed here. With appropriate prepregnancy counseling and planning, most women with RA can safely fall pregnant and continue to enjoy good disease control in pregnancy and the postpartum interval.