In pregnancy, more than any other time, you and your doctor must weigh the benefits and risks of the medications you are taking. Some medications may be required to keep your disease under control – or even save the life of your unborn child – while others may actually cause pregnancy loss or irreparable damage to your baby.
Following is a breakdown of the drugs most commonly used for arthritis. While some are contraindicated during pregnancy, others may be used – or even advised – during pregnancy. In all cases, it’s necessary to work with a rheumatologist and high-risk obstetrician to determine what’s best for you and your baby.
Dangerous/Off-limits
- Chlorambucil (Leukeran) – may cause miscarriage or birth defects
- Cyclophosphamide (Cytoxan) – may cause miscarriage or birth defects
- Leflunomide (Arava) – may cause miscarriage or birth defects
- Methotrexate (Rheumatrex) – may cause miscarriage or birth defects
- Warfarin (Coumadin) – may cause birth defects or severe hemorrhage
Probably Safe
- Cyclosporine (Neoral, Sandimmune)
- Betamethasone (Celestone) crosses placenta, used in late pregnancy to aid lung development in fetuses at risk of premature birth
- Dexamethasone (Decadron, Hexadrol) – also used in late pregnancy to aid fetal lung development; used in mid- and late pregnancy to treat fetal heart block
- Heparin (Calciparine, Liquaemin) – may be used to prevent placental blood clots in women with antiphospholipid antibodies
- Intravenous immunoglobulin
- Low molecular weight heparin – may be used to prevent placental blood clots
- Methylprednisolone (Medrol)
- Prednisone (Deltasone) – may suppress milk production in lactating women
Risk Unknown
- Celecoxib (Celebrex) – large doses cause birth defects in rabbits; effects on people are not known
- Etanercept (Enbrel) – no human studies of effects in pregnancy; no problems found in animal studies
- Infliximab (Remicade) – no animal or human studies of drug’s effects on pregnancy
- Hydroxychloroquine sulfate (Plaquenil) – a recent series of small studies suggests this is safe
- Rofecoxib (Vioxx) – large doses cause birth defects in rabbits; effects on people not known
Variable
- Aspirin – safety is variable and depends on dose and time of use; low doses may protect against pregnancy loss in women with antiphospholipid antibodies, yet may cause bleeding in mother and baby if used too close to delivery; risks of high doses are unknown
- Naproxen (Naprosyn) – Safety is variable and depends on dose and time of use; use near delivery is not advised
- Ibuprofen (Motrin, Advil) – same as naproxen, above
- Ketoprofen (Orudis, Oruvail) – same as naproxen, above
- Nabumetone (Relafen) – same as naproxen, above
- Indomethacin (Indocin) – same as naproxen, above
please kindly assist.
I was first diagnosed with RA in 2009, 1 year after I gave birth to my daughter. However, I questioned my diagnosis because I had been traveling in the Everglades in FL and was bitten by something very strange and unknown. I questioned Lyme disease and still do because of all of my wierd symptoms. I did have a swollen left knee all throughout my pregnancy and shortly before I got pregnant, I suffered planter fascitis. When all of my symptoms really came on in 2009 after the bug bite/sting and after the birth of my daughter, I was first diagnosed with Hashimoto's Disease (hypothyroidism-autoimmune disease).
Then after all other testing had been completed, I tested with a positive rheumatoid factor, high sed rate, and several other tests pointing to RA. I started on Cimzia, Prednisone, and Methotrexate for about 6 months. No change and by now I was on crutches, my left knee was so bad. I decided to treat for Lyme. After being treated with 2 months of antibiotics and no improvement, I started researching and read that arthoscopy can do numbers for the knee and could help. I already had the best knee surgeon lined up and found a new and improved Rheum. Doc who agreed to work with my knee doc to have surgery. I was terrified.
I had the surgery, a biopsy sent out to Mayo to test for Lyme, had my knee cleaned up, tested for all kinds of bacteria and possible infectious diseases and all they could find was RA which I have learned is just a generic term for uncontrolled inflamation throughout your body due to unexplained attack from your immune system on your joints. I started on Prednisone, Plaquinil and Embrel and had a terrific rest of the year.
I was so upset but so happy that I was functional and able to play, dance and have fun with my little girl again.
I have questioned whether or not to have another baby, scared and worried that I will only get worse and not be able to raise my current daughter let alone a new baby.
My faith led me to put it all in God's hands and see what happens. We are pregnant with our 2nd!!! I always wanted to have at least 2 children so that they would always have each other. So far so good and I will continue to pray.
My doc has asked me to stop all medications until I meet with him at the end of the month. So far, I have some pain that has come back in my stiff neck, my left knee(which I had surgery) has been swollen and I have been very fatigued and sore throughout the day. I pray I will be one of the 70-80% of women whose RA remits during pregnancy.
First time around I took prednisone, hydrocodon, and etodolac the whole 36 weeks. I did fine through the first trimester but after that it became difficult. RA flaired.
I hope to do same regiment again. The only thing different is im older, weigh less ,healthier and im more prepared.
You should consult with your doctors (rheumatologist, gyno) regarding medical questions related to medication. You might also want to connect with your local Arthritis Soceity and see if they can connect you with women who have made children while living with Arthritis.
-Fatima
Im 32 and planning to have baby. I have seronegative spondylo arthritis. I am taking
1) Sulfasalazine Delayed release tablets(1gm)(SAAZ-DS) - 2 per day
2) Deflacort tablets (6mg) - 2 per day.
So please let me know whether this drugs are safe to have pregnancy and will not affect the baby.
Regards,
Priya S
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