Are there guidelines for the use of anti-tumor necrosis factor (TNF) drugs to treat rheumatoid arthritis (RA) during pregnancy?

Updated: Mar 05, 2021
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Use of anti-TNF drugs during pregnancy is not covered by current guidelines; the ACR guidelines recommend this topic as a target for future research. [4] Stopping TNF inhibitors at conception has been recommended. [142] However, TNF inhibitors do not cross the placenta until the end of the second trimester. Thus, concern over possible effects on the development of the fetal immune system has led to the suggestion, in the inflammatory bowel disease literature, that anti-TNF drugs can continue from conception through the first trimester but should be stopped during the second trimester. [145]

Analysis of data from the health registries in Denmark and Sweden determined that women who received anti-TNF agents during pregnancy had a slightly higher risk of having children with birth defects. However, the increased risk was not statistically significant. [146]

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