Rheumatoid Arthritis and Pregnancy

“I don’t think it’s anything that is earth shattering, or that patients need to do anything different. But I do think pregnant [RA] patients should let their obstetricians know that they have RA and that this is a possibility.”

Tell Your Patients

The new information is something high-risk obstetrician Jeff Ecker, MD, wants his patients to communicate. He says the research confirms “a notion that had been supported by some data previously,” and is a step in the right direction for patients, rheumatologists and obstetricians.

“We recognize that whenever there is inflammation in the body, whether it stems from an infection or lupus or RA, that there is a cascade that starts that can sometimes provoke preterm labor and delivery,” says Dr. Ecker, director of the maternal fetal medicine fellowship at Massachusetts General Hospital in Boston, and chair of the American College of Obstetrics and Gynecologists’ Committee on Obstetric Practice. “I think this information is very important. The more we can do to start out with a healthy mom, the better.”

Dr. Ecker says that although the study results do not seem overly concerning, he notes that some women with RA may find the increased risks alarming. He says, for that reason, rheumatologists should add this information to their “normal” conversations with women of reproductive age.

“For women with RA who want to become pregnant, a visit in advance of pregnancy to consider these risks, and to consider their course and medications they are taking, is ideal,” he says. “These risks do not seem enormous to me, but there might be some out there that say, ‘Oh my, I’m at this higher risk for preterm labor and delivery. Nope, I’m not going to get pregnant.’ It’s better for them to understand that in advance than for me to be seeing them at 15 weeks and the patient saying, ‘Oh, I wish I had known that.’”

What it all comes down to is a better-informed patient, he adds.

“For women [who] don’t want to become pregnant, because their RA is active or their meds are not great to use in pregnancy, or they just don’t want to be pregnant because of these risks, rheumatologists need to be certain that women of reproductive age, who don’t want to be pregnant, particularly if they have active disease, are using appropriate birth control,” he adds. “We should avoid the, ‘Oh, I really didn’t want you to get pregnant because I am treating you with this drug or your disease is really active, and, oops, now you are pregnant.’”

Future Implications

More importantly, this study gives rheumatologists a starting point to “look further into the health of babies of RA patients,” according to Dr. Zashin.