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Arthritis drugs in pregnancy: What’s safe?

What you need to know

Inflammatory arthritis (IA) affects females more often than males, and is often first diagnosed during childbearing years. Up to half of people with IA who are pregnant still need medications to manage their disease. A survey of Canadian rheumatologists published in 2019 revealed gaps in knowledge on when to stop different IA drugs before or during pregnancy. This study will help shape the future of clinical practice to protect the health of people who are pregnant and their babies.

What is this research about?

Inflammatory arthritis (IA), like rheumatoid arthritis or arthritis caused by lupus, is a chronic disease that more commonly first strikes females in their childbearing years. If IA is not well controlled during pregnancy, it can harm the health of both parent and baby. Up to half of those with IA who are pregnant still need to take some medication. But research evidence on which drugs are safe to use during pregnancy is limited, especially for newer drugs. We didn’t know how much variability there was in what different Canadian rheumatologists do in this situation.

What did the researchers do?

Dr. Mary De Vera and her team surveyed Canadian rheumatologists about their knowledge of medication safety and how they treated pregnant patients with IA. The survey asked about the safety of several pills and biologics in pregnancy, when they should be stopped for someone planning to become pregnant, and what to do in unplanned pregnancies where the expectant parent is already taking medication.

What did they find?

There was an encouraging consensus among the rheumatologists on whether or not many of the drugs should be used during pregnancy. But there were clear knowledge gaps and differences in opinion on when exactly to stop certain drugs and what to do in unplanned pregnancies.

How can this research be used?

These findings give a snapshot of how rheumatologists in Canada manage IA in pregnant people and the areas where they need more evidence to help them deliver the best care. While guidelines for rheumatologists on the use of IA drugs in pregnancy have been developed in Europe and the United States, this study showed that there are still knowledge gaps that need to be filled.

This study’s results can be used to guide research into how to safely and effectively manage IA in pregnancy, highlighting the pressing questions that need to be answered to optimize care. They can also inform the development of improved clinical practice guidelines and be used as a benchmark to see how rheumatologists change their practice as new evidence emerges.

What impact could this have?

By highlighting areas where there is consensus and variability in how Canadian rheumatologists handle IA in pregnancy, this study could inform how treatment decisions are made today.

By encouraging more research and informing improved treatment guidelines, this study could ultimately help ensure healthy pregnancies and healthy babies for those living with IA. This may especially impact the approach to treating IA in the half of pregnancies that are unplanned, where there was a substantial lack of consensus.

About the researchers

Dr. Mary De Vera is a scientist and assistant professor at the University of British Columbia and Arthritis Research Canada. Her research on the safety of arthritis medications in pregnancy was supported by an Arthritis Society Young Investigator Operating Grant awarded in 2013. With the support of a new Arthritis Society Strategic Operating Grant awarded in 2018, she is now leading a pioneering study mapping the connections between arthritis, medication use, and mental health.

Study co-author Dr. Glen Hazlewood, a rheumatologist and assistant professor at the University of Calgary and Arthritis Research Canada, was also supported by an Arthritis Society Young Investigator Salary Award.

Researcher Reflection

Photography of Mary De Vera

I am grateful to all the rheumatologists in Canada who took our survey. I think this shows that the management of IA in pregnancies is an important topic to them.

– Dr. Mary De Vera, University of British Columbia and Arthritis Research Canada

Real-world Reaction

Photography of Stephanie, mother of twins, living with rheumatoid

Research like this is so important. When it came time to start a family, I lived with the anxiety that came from the need to abandon some of my rheumatoid arthritis medication, and how my body would react. Even though I was able to continue my biologic (which had just been approved for use in pregnancy), on its own it wasn’t enough, and I experienced terrible flares in my last trimester.

– Stephanie, mother of twins, living with rheumatoid arthritis

The road to a new pain treatment for women with arthritis

Publication citation

De Vera MA, Baldwin C, Tsao NW, Howren A, Hazlewood GS, Rebić N, Ensworth S. Management of Inflammatory Arthritis in pregnancy: a National Cross-Sectional Survey of Canadian rheumatologists. BMC Rheumatol. 2019;3:18.