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Pregnancy, Rheumatoid Arthritis, and Lupus

by Bonnie L. Bermas, MD

Methotrexate, leflunomide, mycophenolate mofetil, cyclophosphamide. Methotrexate (Rheumatrex, Trexall), leflunomide (Arava), Mycophenolate mofetil (CellCept), and cyclophosphamide (Cytoxan) can cause early fetal death and birth defects at a rate higher than what one would usually expect. Women should not take them during pregnancy. Furthermore, a woman planning a pregnancy should stop taking methotrexate or CellCept at least one menstrual cycle before trying to get pregnant. A man taking either of these drugs who plans to try with his partner for a pregnancy should stop taking it at least three months ahead of time. A woman on leflunomide needs to stop taking it two years before she tries to get pregnant. Or she can undergo a two-week procedure to wash the medicine out of her bloodstream. I tend to avoid prescribing leflunomide for women of childbearing age who want to get pregnant in the near future.

Biologics. There aren’t enough data to conclude whether this newer type of drug is absolutely safe during pregnancy. We know the most about the TNF-alpha blockers — which include etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira) — and recent evidence suggests that these medicines may contribute to birth defects. Women should stop taking biologic drugs before trying to become pregnant.

Summing up

In almost all circumstances, women with RA or lupus can safely become pregnant. Ideally, the RA or lupus should be under control, and pregnancy should be planned. In individuals with lupus in particular, it is helpful to have a team approach, with a rheumatologist and an obstetrician experienced in dealing with women with lupus working together. With careful monitoring and appropriate use of medicines, it is possible to successfully manage pregnancy if you have RA or lupus.

Last Reviewed on September 3, 2010

Bonnie L. Bermas is Assistant Professor of Medicine at Harvard Medical School and Director of the Lupus Center at Brigham and Women’s Hospital in Boston.

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