Do Pregnant Women Really Need Rheumatoid Arthritis Medications?

About 1% of adults in the United States are suffering from rheumatoid arthritis, with more women affected compared to men. Most these women are those still at childbearing age. This indicates the need for a careful family planning mostly those patients who are taking medications. Most of the women, who are suffering from rheumatoid arthritis a common type of arthritis, usually see their symptoms subside during pregnancy periods. However, in some small instances some pregnant women continue to suffer from their RA symptoms even during this period of pregnancy. It is therefore necessary for an RA- pregnant woman to ensure the her RA medications have been modified to suit the needs of pregnancy, and this will avoid any side effects from the drugs to get the developing fetus. This is important so as to control flares and at the same time minimizing the risks of RA medications from affecting the developing fetus.

Changes in Rheumatoid Arthritis During Pregnancy
There are so many immune system changes that take place during the stage of pregnancy. These changes are necessary for the growth of the developing fetus. However, some of these changes may lead to some side effects to the expectant mother; and one of then is rheumatoid arthritis. During pregnancy, it is estimated that about 50-60% of women suffering from RA show some significant improvements when pregnant.  Sometimes, it is difficult to distinguish between the normal discomforts of pregnancy and those symptoms associated with RA.  RA symptoms that are similar to those of Pregnancy include the following:

• Fatigue
• Swelling of the feet, hands or ankles
• Lower Back Pain
• Breathe Shortness
•  Pain or Numbness in one or both hands
• Pregnancy outcome: majority of reports point that there is no increase in miscarriage in women who have RA.  In some medications like high dosages of steroids however, there could be an increase in the risk of developing a smaller infant and this may increase the risk of premature damage of the membranes.

Care Before Pregnancy
It is important for Women with RA to discuss with their doctor their desire to become pregnant with an arthritic condition.

•  A pregnant women need to share with their doctor about the implications any RA drug they are using have on pregnancy. Some medications can be safer during pregnancy while others are not.
• It is important for those women who are taking methotrexate to cease from using this medicine foe a period close to one month before attempting to conceive, although it is best to allow one to three full menstrual cycles to pass before attempting pregnancy. In the case of men, those who are using this methotrexate should avoid it three months to meeting their wives.
• This waiting period is crucial in that it allows those effects of methotrexate on the body to get out so that it will be safe to become pregnant.
• If there are Women who taking leflunomide, they  must stop it for at least two years before conceiving; they can only conceive much earlier unless they do some treatments to eliminate the drug from the body. This is the reason why any childbearing woman must share the implications of arthritic medications to their pregnancy.

Treatment of Rheumatoid Arthritis during Pregnancy
Some of the women with RA flare during pregnancy and due to this, they require treatment. However, it is worth to note that some medications used in the treatment of RA can be harmful to the fetus. The benefit of any RA medication must be balanced with the potential risk.

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Care during pregnancy: it is important to share the care of RA women during pregnancy between rheumatologist and obstetrical provider.

Medications during pregnancy:  This area has not been studied well; this is why the effects the medication will have on the fetus. The decision on which drug to be given to a particular patient will depend on the response the treatment will have on her.

• What needs to be avoided completely during pregnancy is Methotrexate and leflunomide, due their harmful effects on the fetus. If by any case a pregnant woman could be taking one of these drugs, she needs to speak it immediately with her clinician. Some of the drugs that can be taken more carefully during pregnancy include nonsteroidal anti-inflammatory drugs and aspirin.
• There are variant benefits of the drug between various mothers; to some, the benefits of the drug in managing the disease and maintaining function outweigh the possible risks to the fetus or the mother. It is therefore very important for a pregnant mother who is also suffering from RA to discuss any medication to manage the disease with her clinician. This will ensure that any possible side effects either to the mother or the fetus are avoided.

Rheumatoid Arthritis after Delivery
It is Approximated that about 90% of women with RA will experience a flare during the postpartum period. This is so during the first three months and more particularly after a woman’s first pregnancy. It is recommended that for continuation purposes, RA medications should be restarted few weeks after delivery.

Breastfeeding and RA activity: It is actually not very clear whether RA drugs have any negative side effects to breastfeeding. There are so many benefits of breastfeeding, for both the mothers and their children. This is why those women with RA and are willing to breastfeed their infants are encouraged to do so.

Medications and breastfeeding: almost all the conditions used during pregnancy are also used when the mother is breastfeeding.

• It is recommended that mothers can use Nonsteroidal anti-inflammatory drugs (NSAIDs) but they should avoid using aspirin to relieve any pain associated with RA or pregnancy.
• Prednisone drug can be taken in low doses.
• Azathioprine, Methotrexate and cyclosporine should both be avoided during breastfeeding. One area where there has not been enough information on the safety of tumor necrosis factor (TNF) inhibitors such as adalimumab, etanercept or infliximab during breastfeeding. However, many experts are in agreement that minimal amounts of these medications will be absorbed by the nursing infant via its stomach.

 References

• Majithia V, Geraci SA (2007). “Rheumatoid arthritis: diagnosis and management”. Am. J. Med. 120 (11): 936-9. doi:10.1016/j.amjmed.2007.04.005. PMID 17976416.
• Bannwarth, B; Labat, L; Moride, Y; Schaeverbeke, T (January 1994). “Methotrexate in rheumatoid arthritis. An update.”. Drugs 47 (1): 25-50. doi:10.2165/00003495-199447010-00003. PMID 7510620
• Østensen ME, Skomsvoll JF (March 2004). “Anti-inflammatory pharmacotherapy during pregnancy”. Expert opinion on pharmacotherapy 5 (3): 571-80. doi:10.1517/14656566.5.3.571. ISSN 1465-6566. PMID 15013926.