Adverse Effects of Rheumatoid Arthritis Medicines on Pregnant Women and Fetus

Certain drugs for rheumatoid arthritis may lead to abortion or stillbirth if used during pregnancy.

Highlights:

The study evaluated effects of Antirheumatic drugs on pregnant women diagnosed with rheumatoid arthritis
Drugs Methotrexate and Leflunomide must be avoided before and during pregnancy
Some Antirheumatic drugs carry a potential risk of causing stillbirths and abortions

Rheumatoid Arthritis (RA) is a common autoimmune disorder affecting about 1% of the worldwide population. Women who are in the child-bearing age can experience rheumatoid arthritis (RA) during this period, and the impact of RA on pregnancy varies depending on the condition ().

Rheumatoid Arthritis has been reported to cause adverse effects on pregnant women and fetal health. Further, during pregnancy, the woman may need to take medicines for treating rheumatoid arthritis to reduce pain and inflammation but these medications are also known to cause adverse effects on women and their unborn child. Therefore, it is necessary to closely monitor the health of pregnant women suffering from rheumatoid arthritis.

Rheumatoid Arthritis Treatment During Pregnancy
Negligible placental transfer of the anti-TNF drug certolizumab pegol(CZP)from mothers to infants during pregnancy were observed.

‘Did you Know?
Some Antirheumatic medications can cause serious adverse effects on pregnancy and lead to abortion or stillbirth. #rheumatoidarthritis #pregnancy #antirheumaticmedications #medindia’

Clinical Study: Impact of Antirheumatic Medications on Pregnancy

A recent study has been reported in the journal, Rheumatic & Musculoskeletal Diseases, to investigate the adverse effects of medications prescribed for RA, on pregnant women and fetuses. The study was done on female patients selected from the Korean National Health Insurance database and were in the age group of 20-50 years. The study observed the trend of using anti-rheumatic medications during pregnancy and to identify factors that could lead to adverse outcomes in pregnancy ().

Based on the outcome of pregnancy, the study was divided into two groups: the delivery group and the adverse outcome group. The group of adverse outcomes included cases reported with abortion and stillbirths. The study included 5,728 subjects, of which 4,576 belonged to the delivery group and 1,152 subjects to the adverse outcome group. It was noted that there was a difference in the use of medications between the two groups before conception.

The second group that experienced adverse outcomes had frequently used Methotrexate, Leflunomide, and NSAIDs. In contrast, the first group, known as the delivery group, had stopped using Methotrexate and Leflunomide before the commencement of pregnancy.

Rheumatoid Arthritis During Pregnancy – Risk for Premature Birth
Rheumatoid arthritis during pregnancy is associated with low birth weight and premature birth. No adverse outcome is found for mothers with rheumatoid arthritis except premature delivery, according to the European League against Rheumatism.

Results concluded that treatment with Methotrexate and Leflunomide were primary causes of adverse outcomes in pregnancy ().

The drug Methotrexate, taken three months before conception, can lead to abortion, as it is teratogenic in humans.

Is It 'Safe' to take Anti-TNF Medications during Pregnancy?
Pregnant women with Crohn's disease and rheumatoid arthritis can use Anti-tumor necrosis factor medications (anti-TNFs), as they help prevent chronic inflammatory diseases.

Drugs Causing Adverse Event in Rheumatoid Arthritis

Leflunomide, a non-biologic drug, categorized under DMARDs (Disease modifying antirheumatic drugs) can cause lethal effects on the unborn child.

However, other non-biologic DMARDs such as Sulfasalazine and Hydroxychloroquine, were safe to use. However, their use has decreased in recent years.

Mother’s Arthritis - Risk for Chronic Disease in Offspring
Rheumatoid arthritis during pregnancy may increase chronic disease risk in children. Fetal exposure to maternal rheumatoid arthritis (RA) increases risk.

The use of Tacrolimus (another non-biologic DMARD) has been increasing in organ transplants and other conditions and it can be used at the lowest effective dose throughout pregnancy.

The biologic DMARDs (bDMARDs) like Adalimumab, Infliximab, Etanercept, and Certolizumab affect the pregnancy at various trimesters.

Each drug should be evaluated separately by the healthcare provider, to determine its suitability for use or discontinuation during a specific trimester.

Certolizumab is reported to be safe and can be used throughout all trimesters of pregnancy.

This study had limitations, as factors like the effect of RA disease activity, body mass index, and smoking were not part of the study. The scientists suggested further studies be conducted based on their report.

Precautions to be taken During pregnancy, doctors may also prescribe the use of drugs classified as Glucocorticoids. However, these drugs should be given at the lowest dose during pregnancy.

According to a report in the Chinese Medical Journal, research had shown that pregnant women who had rheumatoid arthritis and took daily doses of Prednisone >7.5 mg had higher preterm birth rates and lower fetal weight compared to those taking lower doses or no Prednisone. This observation was believed to be related to the effect of hormones on pregnancy conditions.

Pregnant women who are suffering from RA (rheumatoid arthritis) must consult their healthcare providers before taking any medication. This is to ensure their well-being and the development of the fetus. It is also vital for healthcare providers to assess each case as an individual case and prescribe medications with minimal toxicity to pregnant women or fetus, followed by close medical supervision.

References:

Medication utilisation trends during pregnancy and factors influencing adverse pregnancy outcomes in patients with rheumatoid arthritis - (https://rmdopen.bmj.com/content/rmdopen/10/1/e003739.full.pdf)
Maternal and fetal outcomes in pregnant women with rheumatoid arthritis: a systematic review and meta-analysis - (https://pubmed.ncbi.nlm.nih.gov/36357630/)
Adverse effects of maternal rheumatoid arthritis during pregnancy on children - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116023/)

Source-Medindia