If you want to consider a pregnancy while living with rheumatoid arthritis (RA), one of the most difficult decisions you’ll have to make is how to treat your disease during your pregnancy. While some women may experience remission while they are pregnant, it turns out this percentage is not as high as previously thought. The initial report from about 30 years ago suggested that 70 to 75% of women with RA would achieve some degree of remission, but today doctors estimate that number is closer to about 48%.
Since there’s a real chance of dealing with active disease during pregnancy, you’ll definitely want to discuss all of your treatment options with your rheumatologist prior to becoming pregnant. The good news is, if you end up needing them, there is some exciting new data to support the use of biologic medications to manage RA during pregnancy!
At the recent American College of Rheumatology (ACR) Annual Meeting in San Diego, California, Dr. Christina Chambers presented data from a study conducted by the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project. Since biologic medications work by suppressing your immune system, the study set out to discover whether infants exposed to biologic medications during pregnancy could be at an increased risk for infection after birth.
The study included data from pregnant women in the U.S. and Canada from 2004 to 2016. In 502 pregnancies, the mother with RA had been treated with a biologic medication at some point in her pregnancy. This group was carefully compared to 231 pregnancies where the mother had RA but did not use any biologics during pregnancy, and 423 pregnancies where the mother had no chronic disease at all.
The researchers collected data by interviewing the mothers over the phone at several points during their pregnancies and by obtaining follow up data on the infants’ infection rates for up to one year after birth from their pediatricians. The researchers focused on serious and opportunistic infections such as: neonatal sepsis, invasive fungal infection, X-ray proven pneumonia, meningitis, bacteremia, pneumocystis, septic arthritis, osteomyelitis, tuberculosis, herpes, listeria, legionella, mycobacteria, systemic cytomegalovirus, and abscess.
The good news is that the researchers discovered using a biologic medication to manage RA during pregnancy did not appear to significantly increase the infant’s risk of developing serious opportunistic infections after birth. This finding was still true even among infants potentially exposed in the third trimester, when most experts believe placental transfer of medications is increased. This evidence is very encouraging for women with RA who need to be treated throughout their pregnancy with a biologic medication. (Dr. Chambers did note, however, that this study does not answer the question of whether infants should avoid live vaccines after birth if they have been exposed to biologics during pregnancy, so that is still an important issue to discuss with your doctor!)
Personally, I found this news to be particularly exciting for two reasons. First, I’m currently pregnant with my third baby, and since I flared badly during my last pregnancy I made the decision to stay on a biologic during this pregnancy. I find it very reassuring to know that by taking care of myself and treating my RA during this pregnancy I’m not putting my baby at any additional risk of serious infections after birth.
Secondly, I feel a strange sense of pride in these study results, as I’m fairly certain my second son and I actually contributed data to this study! I was pregnant with him in 2014, had to take a biologic during my third trimester to control a bad flare, and immediately enrolled in the OTIS database. During that pregnancy I participated in a few phone interviews, authorized my pediatrician to contribute our data, and had a pediatrician from the study come evaluate my son (who was perfectly healthy!) a few weeks after he was born.
I find it very exciting to think that this small amount of effort on my part may have contributed to a finding that could allow women with RA to have easier pregnancies and less guilt as mothers. If you are considering staying on a medication during pregnancy, I highly recommend speaking to Mother to Baby (a service of OTIS) to see if there is a study that you can contribute to! These decisions are very complicated, so we should do everything we can to make things easier for future mamas! In the meantime, it’s very exciting to see more safe treatment options for women with RA who want to become mothers.