Rheumatoid arthritis and planning a pregnancy

Julia Rees is a mother and occupational health doctor from Surrey, UK, who has rheumatoid arthritis.

Most women these days plan their pregnancies. Many will consider carefully how to prepare themselves preconceptually in order to achieve the best possible outcome. Many will change their diet, give up smoking and adopt a generally healthier lifestyle. Most will also alter any prescription drugs as necessary, as well as avoid unnecessary self-medication.

Drugs can have harmful effects on the foetus at any time during pregnancy and therefore should only be prescribed if the expected benefit to the mother is thought to be greater than the risk to the foetus.

Certain drugs, e.g. cytotoxics such as methotrexate, should be stopped in both males and females prior to trying for a pregnancy as most cytotoxic drugs are teratogenic and may produce congenital malformations. The greatest likelihood of teratogenesis is in weeks 3-11 of pregnancy while the foetus is forming. Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided during pregnancy; these may cause different problems during different stages of pregnancy including delivery.

Low dose corticosteroid therapy may be a good option (one that I had). But it needs to be monitored and extra cover may be required during labour.

Drugs given in the second and third trimester may affect the growth and functional development of the foetus or have a toxic effect on the foetal tissues.

Breastfeeding is an important part of the care of newborn for many mothers but there are drugs that pass into breast milk, which may cause toxicity to the infant, advice should therefore always be sought regarding this. I stopped breastfeeding at four months in order to start new treatment (cytoxic).

The general practitioner (GP) is usually the first port of call for advice. The GP should be able to supply the required information, especially if armed with an up- to-date copy of the British National Formulary (BNF) that has sections on pregnancy and breastfeeding as well as telephone numbers for further information regionally. Alternatively, it may be worthwhile discussing drugs with a specialist (rheumatologist or obstetrician) if you have one.

First published in Disability, Pregnancy & Parenthood international, Issue 30, April 2000.

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