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Review
. 2025 Mar;39(1):102022.
doi: 10.1016/j.berh.2024.102022. Epub 2024 Nov 20.

Management of pregnant with rheumatoid arthritis: Preconception care, pregnancy and lactation strategies, and maternal-fetal outcomes

Takehiro Nakai  1 , Sho Fukui  2 , Hiroki Ozawa  3 , Ayako Kitada  4 , Masato Okada  3 , Mitsumasa Kishimoto  5
Affiliations
Review

Management of pregnant with rheumatoid arthritis: Preconception care, pregnancy and lactation strategies, and maternal-fetal outcomes

Takehiro Nakai et al. Best Pract Res Clin Rheumatol. 2025 Mar.

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that can affect women of reproductive age. In recent decades, significant advances have been made in the development of new medications, including biologic disease-modifying anti-rheumatic drugs (DMARDs) and Janus kinase (JAK) inhibitors. Women with RA are prone to infertility, with 42% experiencing a time to pregnancy exceeding 12 months. High disease activity, as well as the use of high-dose glucocorticoids and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), are associated with infertility and adverse pregnancy outcomes. Additionally, some medications, such as methotrexate, are linked to teratogenicity, highlighting the importance of providing preconception care in everyday practice. Recent advancements in reproductive care have improved our ability to manage RA during pregnancy, leading to better pregnancy outcomes. In this review, we summarize key aspects of fertility care, pregnancy and lactation management, including medication strategies, neonatal vaccination, and long-term outcomes for offspring born to mothers with RA.

Keywords: Lactation; Neonatal vaccination; Pregnancy; Rheumatoid arthritis.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Masato Okada reports a relationship with Eli Lilly and Company, Santen Pharmaceutical, Mitsubishi Tanabe Pharma, Pfizer, and Abbott, Japan that includes: speaking and lecture fees. Mitsumasa Kishimoto reports a relationship with AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma. That includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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