Rheumatoid Arthritis medicines use during pregnancy linked to adverse outcomes in new study

In a groundbreaking investigation, researchers have delved into the medication utilization patterns during pregnancy among women grappling with rheumatoid arthritis (RA). The study concludes that appropriate medication adjustment is quite necessary when planning for pregnancy among women with RA.

The study results were published in the journal Rheumatic & Musculoskeletal Diseases.

Patients diagnosed with rheumatoid arthritis (RA) often face challenges when it comes to achieving favorable pregnancy outcomes, as compared to individuals in the general population. This disparity underscores the need for careful consideration and specialized management for female patients with RA who are planning for pregnancy and lactation, as they encounter limited treatment options.

By drawing on data from the Korean national health insurance database spanning a decade from 2010 to 2020, sheds light on critical factors influencing pregnancy outcomes for this vulnerable population. Led by a team of esteemed scientists, the study focused on female patients aged 20 to 50 years diagnosed with RA. Pregnancy episodes were meticulously analyzed and categorized into two distinct groups: those resulting in successful delivery and those culminating in adverse pregnancy outcomes (APOs), encompassing instances of abortion and stillbirth.

Findings:

• The findings, published in a reputable medical journal, unveiled crucial insights into medication utilization trends and their implications for maternal and fetal health.
• Among the 5728 pregnancy episodes scrutinized, a stark contrast emerged between the delivery group, comprising 4576 episodes, and the APO group, encompassing 1152 episodes.
• Remarkably, the study revealed hydroxychloroquine as the predominant conventional synthetic disease-modifying antirheumatic drug (DMARD) prescribed both prior to conception and throughout pregnancy in both cohorts.
• However, a noteworthy decline in the prescription rates of all DMARDs was observed as pregnancies progressed, signaling cautious medication management during gestation.
• Of paramount significance were the revelations from the multivariable logistic regression analysis, which pinpointed two specific medications—methotrexate and leflunomide—as posing heightened risks for APOs.
• The use of these drugs within three months preceding conception was associated with significantly increased odds ratios of 2.14 and 2.68, respectively, underscoring the imperative for judicious medication adjustments when planning pregnancy among women with RA.

Moving forward, efforts to enhance awareness and facilitate informed decision-making among patients and healthcare providers alike are paramount. By fostering a collaborative approach grounded in evidence-based practices and patient-centered care, we can empower women with RA to navigate pregnancy with confidence and mitigate the risks posed by medication exposures.

Further reading: Song YJ, Cho SK, Jung YS, et al. Medication utilisation trends during pregnancy and factors influencing adverse pregnancy outcomes in patients with rheumatoid arthritis. RMD Open. 2024;10(1):e003739. Published 2024 Mar 22. doi:10.1136/rmdopen-2023-003739.