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Are the Babies OK in Moms with RA? Tips for Management
November 15 2016 1:00 PM ET — via RheumReports
Several abstracts at the ACR 2016 rheumatology meeting in Washington DC addressed drugs and pregnancy outcome.
Are NSAIDs OK in pregnancy? Maybe.
We've been told that pregnant women should avoid NSAIDs to prevent premature closure of the ductus arteriosus of the fetus. 855 patients with inflammatory arthritis, of whom 1/3 were on NSAIDs including nearly 92 using NSAIDs up to 38 weeks, showed no problem – but the study is likely underpowered (Amiri N, et al. ACR 2016 #2442). Caution should be used with NSAIDs near the end of pregnancy, but this supports what many rheumatologists and patients are already doing.
Does RA affect fertility and parity? Maybe, yes.
In a meta-analysis, 5 studies showed no differences in parity and fertility in RA patients compared to age-matched population control women (Murphy CL, et al. ACR 2016 #2450), 8 studies reported decreased fertility and early menopause, and 9 studies showed reduced parity and increased pregnancy loss.
Does RA improve during pregnancy? Yes, but not as often as we thought.
A systematic review of 86 articles that included nearly 1000 pregnancies suggsts that only half of RA patients had objective improvement in disease activity during pregnancy (Jethwa H, et al. ACR 2016, #1517). This contrasts to what I have thought – more like ¾ despite stopping their drugs often.
Do the babies of RA moms have more problems? Maybe, but not much.
An Alberta billing database showed more C-sections in moms with RA matched by age to other mothers and more babies that were small for gestational age (Keeling S, et al. ACR 2016, #992). These data for slightly smaller babies and data from a Scandinavian population that also showed slightly earlier babies, seem to be consistent but adverse pregnancy outcomes are not in the range of SLE.
Is breastfeeding OK when on a TNFi? Likely yes.
One study showed Cimzia mostly does not transferinto breast milk (Clowse MEB, et al. ACR 2016, #2048). This makes sense sincein general, proteins are water soluble and breast milk is highly fat soluble. This is reassuring datato tell your RA patients who choose to breastfeed.
What should I do when my RA mom goes in to labour when she flared with the previous pregnancy? Give IM or IV or PO steroids.
This is just a tip from what I do. If a mom flared after a previous pregnancy or is flaring during a currentpregnancy, I give steroids while in labour such as 100 mg IV or 80 mg IMor a pulse of oral over the next 5 to 10 days. This may prevent a flare or worsening. I give the mother a letter for when she goes to deliver.
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About the Author
Dr. Janet Pope
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.
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