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Explore This IssueOctober 2012
What the Current Data Show
For many decades, data on RA disease activity during pregnancy supported the notion that the great majority of patients experienced improvement or even remission of active disease during pregnancy, with improvements noted early in gestation and continuing through delivery.2 There was little corresponding study of the effects of RA upon pregnancy outcome. However, more recent data have cast some doubt on the magnitude of disease quiescence during pregnancy and the notion that fetal outcomes are unrelated to maternal disease activity. Prospective observational studies performed within the last decade using standardized measures of disease activities have begun to quantify the extent of disease burden during pregnancy. These have shown, in general, that there continues to be a good proportion of RA patients who experience improvements in disease activity during pregnancy.
However, in contrast to earlier reports, these data demonstrate that fewer than half of patients with moderate disease at conception experience a moderate or good response according to European League Against Rheumatism criteria by the third trimester, leaving the remaining women with a Disease Assessment Score–28 of >3.2 (intermediate and severe disease activity) during pregnancy.3 In the nonpregnant patient, this would be considered a failure. One could argue that pregnancy is an exception to the treat-to-target goals for two reasons: 1) this is a short period of time in a woman’s lifetime of RA; and 2) past data suggested no adverse pregnancy outcomes, therefore the risks of active disease to the fetus are too low to consider potential teratogenic risk of medication exposure.