How does pregnancy affect the course of rheumatoid arthritis (RA)?

Updated: May 11, 2018
  • Author: Katherine K Temprano, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Pregnancy alters the immune state, possibly contributing to a change in the course of rheumatoid arthritis (RA). [1, 2]  Approximately 50% of pregnant women with RA have low disease activity, and 20% to 40% achieve remission by the third trimester; however, nearly 20% will have worse or moderate-to-high disease activity during pregnancy that may require further therapeutic intervention. [3]

Women also experience postpartum flares. One study reported that disease activity decreased during pregnancy but increased after delivery. [4] The investigators monitored 84 patients with RA for disease activity before conception; at each trimester of pregnancy, if possible; and at 6, 12, and 26 weeks postpartum. Among patients with at least moderate disease activity in the first trimester, at least 48% had a moderate response during pregnancy, whereas patients with low disease activity in the first trimester reported that their disease activity remained stable during pregnancy. [4] Thirty-nine percent of patients had at least 1 moderate flare postpartum.

No specific guidelines address obstetric monitoring in patients with RA. Because few available data suggest a significantly increased risk for preterm birth, preeclampsia, or fetal growth restriction, no special obstetric monitoring is indicated beyond what is performed for usual obstetric care. [5]

Go to Rheumatoid Arthritis for more complete information on this topic.


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