Many women with rheumatoid arthritis (RA) experience healthy pregnancies and deliver healthy babies. In fact, the Arthritis Foundation reports that around 70% of women with RA actually see an improvement in their arthritis symptoms during pregnancy, starting in the second trimester. Still, if you have RA you need to be cautious about which rheumatoid arthritis medications you take during pregnancy. In fact, if you plan to become pregnant you should talk with your doctor about your RA treatment before you conceive, since some RA drugs can begin to affect a baby’s development from the earliest moments of pregnancy. If you find yourself pregnant unexpectedly, see your rheumatologist as soon as possible to discuss your RA medications. Why Medication Choice Matters in RA Pregnancy Before any drug receives approval for use in the United States, the manufacturer must conduct studies regarding its safety. These studies rarely involve pregnant women because it would be unethical to expose a fetus to an unknown drug. However, manufacturers do test medication safety on pregnant animals, such as mice. These results help predict how the drug might act on a human fetus. Many drugs for a variety health issues are known to cause birth defects in developing babies. With other medications, it’s unclear whether or not the drug might have an adverse effect on a fetus. And still other drugs, like acetaminophen (Tylenol), are generally considered safe to take during pregnancy. Treatment for RA can include medications from each of these groups. Be sure to inform your doctor if you are planning to become pregnant or may have recently become pregnant. You should rely on your doctor’s experience and expertise to help you choose RA treatment medications that will manage your symptoms while not exposing your unborn child to unnecessary risks. RA Medications You Should Avoid During Pregnancy Becoming pregnant does not mean you have to stop treating your rheumatoid arthritis. It does mean, however, that your doctor may need to change your medications to avoid harming your baby. For example, your doctor will want you to discontinue the drugs on this list, because they can cause miscarriage, birth defects, or hemorrhage (bleeding): Chlorambucil (brand name Leukeran) can inhibit the development of a baby’s kidneys in utero. Cyclophosphamide (Cytoxan) can cause multiple birth defects including microcephaly and facial defects. Leflunomide (Arava) can cause multiple fetal abnormalities and should be discontinued at least two years before becoming pregnant. Methotrexate (Rheumatrex) is toxic to embryos and can cause miscarriage. Warfarin (Coumadin) may not directly affect the fetus, but as a blood thinner it can cause hemorrhage during the pregnancy. If you unexpectedly become pregnant and currently take a drug on this list, call your doctor right away for information about how to discontinue these medications—and what to take instead. RA Medications You Might Need to Avoid During Pregnancy For many RA drugs, manufacturers do not know the precise risk of use during pregnancy. Some doctors consider the following RA medications safe to take during pregnancy, while others will want you to avoid them. You should consult closely with your rheumatologist regarding the potential fetal risks of using these medications while pregnant: Abatacept (Orencia) has not been adequately studied in relation to human pregnancy. Cyclosporine (multiple brand names) might cause low fetal birth weight, but still may be prescribed during pregnancy in certain circumstances. Corticosteroids and glucocorticoids (Prednisone and others) can produce unwanted fetal side effects at certain points during pregnancy, so your doctor may lower your dose or discontinue these meds until after delivery. Hydroxychloroquine sulfate (Plaquenil) crosses the placenta, and the potential fetal effects have not been adequately studied. Rituximab (Rituxan) might adversely affect the infant’s immune system. TNF inhibitors (adlimumab, etanercept, and others) may be considered safe by some doctors, while others recommend discontinuing them out of an abundance of caution because these agents have not been adequately studied in human pregnancy. RA Drugs That Are Probably Safe to Take During Pregnancy Most rheumatologists consider the following RA medications safe to take during pregnancy: Anakinra (Kineret) has not been shown to cause birth defects in animal studies. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) likely are safe to take at recommended doses, though you should follow your doctor’s advice. Azathioprine (Imuran) is probably safe to take in pregnancy, but not when breastfeeding. Celecoxib (Celebrex) is considered safe to take throughout pregnancy at recommended doses. Heparin and low molecular weight heparin can be useful in preventing blood clots in women with RA who develop clots or exhibit a high risk of clots during pregnancy. Immunoglobulin (RhoD) has not exhibited adverse effects on fetuses. Sulfasalazine has a long track record of safety during pregnancy. Rheumatoid arthritis need not prevent you from experiencing pregnancy and expanding your family. With expert advice from your doctors, you can manage your RA symptoms with medications that won’t harm your unborn child.