For Your Patients: Reproductive Health in RA

As the treatment of rheumatoid arthritis (RA) has grown increasingly safe and effective during recent decades, questions about your quality of life -- including reproductive health among young women -- have grown in importance. These concerns include the optimal use of birth control and family planning, difficulties in becoming pregnant, and treatment with medications associated with birth defects and miscarriage. Experts offer the following advice.

Fertility: Control the Disease

Some women with RA have found it more difficult to become pregnant than women without the disease, but the most important thing you can do is work with your rheumatologist to ensure your disease is well under control for at least 3 to 6 months before you even try to become pregnant. Many studies have demonstrated better pregnancy outcomes among women whose disease is well controlled before they become pregnant, and uncontrolled disease has been linked with preterm birth and babies who are small for gestational age.

Pregnancy: Medications Matter

One of the most common medications used for RA is methotrexate, which is quite effective in controlling the disease in many patients. However, this drug has been associated with miscarriage and serious fetal abnormalities, and must be stopped before you become pregnant.

Fortunately, another class of drugs called TNF inhibitors, now in use for more than two decades, has been found to be safe to use throughout pregnancy as well as during breastfeeding. The TNF inhibitors include adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), and infliximab (Remicade). You will need to talk to your rheumatologist about whether these drugs are right for you if you are considering becoming pregnant.

You also may be taking steroids such as prednisone to help control your disease, and if so, the dosage may need to be lowered during pregnancy. Steroids given in high doses during pregnancy could lead to complications such as gestational diabetes and hypertension.

But one fortunate aspect to pregnancy in RA is that many women actually go into remission during this time and may be able to stop medications for the duration of the pregnancy. It's not clear which women will experience improvements in RA during pregnancy, but it's been estimated that this occurs in up to half of women with the disease. And experts agree: The likelihood for women with RA today to have a safe and successful pregnancy is high.

Contraception: Address It Early

Because of the importance of gaining adequate control of RA before you attempt pregnancy, you will need to talk to your rheumatologist early and often about the most effective methods of contraception.

For women with RA, the most effective methods of birth control are IUD and progestin implants, but other options include progestin-only and combined estrogen-progestin pills as well as depot medroxyprogesterone injections. Your rheumatologist will need to coordinate your contraceptive care with your ob-gyn and other specialists as needed to provide the best outcome for both you and your family.

Read previous installments in this series:

What Is Rheumatoid Arthritis?

How Is Rheumatoid Arthritis Diagnosed?

Starting Treatment for Rheumatoid Arthritis

Beyond the First RA Treatments

Special Concerns About COVID

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.