title: Patterns of medication use during pregnancy in rheumatoid arthritis.
abstract: OBJECTIVE
  To characterize therapies prescribed during pregnancy to women with rheumatoid arthritis (RA).
  
  
  METHODS
  We conducted a cohort study of women with RA with pregnancies using health care utilization data from 2002-2008. We examined the distribution of RA drugs by therapeutic classes, including nonsteroidal antiinflammatory drugs (NSAIDs)/coxibs, glucocorticoids, nonbiologic disease-modifying antirheumatic drugs (DMARDs), and biologic DMARDs, during 90-day pregnancy trimesters and the 180 days prior to pregnancy. Drugs were characterized according to the Food and Drug Administration risk classification system. Differences in exposure by period were determined by chi-square tests.
  
  
  RESULTS
  A total of 393 pregnancies were identified among 34,169 women with RA. Seventy-two percent of pregnancies ended in a delivery. Approximately 24% of women with RA received a DMARD during preconception. At any point during pregnancy, 23% of women with deliveries were dispensed ≥1 DMARD and the proportion of use declined from the first to the third trimester (P = 0.03). Similar to DMARD therapy, use of NSAIDs/coxibs and exposure to category D/X medications were significantly lower compared to prepregnancy use (P < 0.05). In contrast, more women were prescribed glucocorticoids during pregnancy than before pregnancy. Use of biologics occurred in 12.5% of pregnancies. Compared to women with deliveries, women who experienced abortions were more frequently exposed to NSAIDs/coxibs (P < 0.05). Dispensing of category D/X medications was also higher in women with spontaneous abortions and primarily involved methotrexate (P < 0.05).
  
  
  CONCLUSIONS
  Approximately 24% of women with RA received a DMARD in the 180 days before conception, and the proportion dropped during pregnancy. Glucocorticoid use remained high throughout pregnancy. Our results suggest that continued efforts directed at counseling women and their physicians about the potential risks/benefits of RA therapies during pregnancy are warranted.
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, USA. bindee.kuriya@gmail.com
authors.forename: Bindee
authors.initials: B
authors.lastname: Kuriya
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernández-Díaz
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Bermas
authors.forename: Gregory
authors.initials: G
authors.lastname: Daniel
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003376:Counseling; D019992:Databases as Topic; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States
chemical_list: D018501:Antirheumatic Agents