Management of pregnant with rheumatoid arthritis: Preconception care, pregnancy and lactation strategies, and maternal-fetal outcomes

Takehiro Nakai; Sho Fukui; Hiroki Ozawa; Ayako Kitada; Masato Okada; Mitsumasa Kishimoto

doi:10.1016/j.berh.2024.102022

Management of pregnant with rheumatoid arthritis: Preconception care, pregnancy and lactation strategies, and maternal-fetal outcomes

Best Pract Res Clin Rheumatol. 2024 Nov 20:102022. doi: 10.1016/j.berh.2024.102022. Online ahead of print.

Authors

Takehiro Nakai¹, Sho Fukui², Hiroki Ozawa³, Ayako Kitada⁴, Masato Okada³, Mitsumasa Kishimoto⁵

Affiliations

¹ Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan. Electronic address: nowhereman1106@outlook.jp.
² Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan; Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Emergency and General Medicine, Kyorin University School of Medicine, Tokyo, Japan.
³ Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan.
⁴ Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan; Department of Rheumatology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
⁵ Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan; Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan.

PMID: 39572276
DOI: 10.1016/j.berh.2024.102022

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that can affect women of reproductive age. In recent decades, significant advances have been made in the development of new medications, including biologic disease-modifying anti-rheumatic drugs (DMARDs) and Janus kinase (JAK) inhibitors. Women with RA are prone to infertility, with 42% experiencing a time to pregnancy exceeding 12 months. High disease activity, as well as the use of high-dose glucocorticoids and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), are associated with infertility and adverse pregnancy outcomes. Additionally, some medications, such as methotrexate, are linked to teratogenicity, highlighting the importance of providing preconception care in everyday practice. Recent advancements in reproductive care have improved our ability to manage RA during pregnancy, leading to better pregnancy outcomes. In this review, we summarize key aspects of fertility care, pregnancy and lactation management, including medication strategies, neonatal vaccination, and long-term outcomes for offspring born to mothers with RA.

Keywords: Lactation; Neonatal vaccination; Pregnancy; Rheumatoid arthritis.

Publication types

Review