title: Pregnancy and rheumatoid arthritis.
abstract: Fertility is impaired in female patients with rheumatoid arthritis (RA), which is related to disease activity and the use of certain medication. During pregnancy, disease activity usually improves, but less than previously thought. Especially in women with high disease activity, the pregnancy outcome is also impaired. All of this underscores the importance of strict control of disease activity in RA patients who wish to conceive. Management of RA disease activity during pregnancy might be a challenge as the treatment options are limited. Evidence is accumulating that tumor necrosis factor (TNF) blockers can be safely used during pregnancy, particularly during the first trimester and the beginning of the second trimester. Far less is known about the problems faced by male RA patients who wish to conceive, in terms of not only fertility and pregnancy outcome but also the safety of medication. In this paper, the fertility issues in patients with RA, the pregnancy-associated improvement of RA, the pregnancy outcomes, including the long-term effects on the offspring, and treatment options, including those during lactation and for male patients wishing to conceive, will be reviewed.
authors.affiliation: Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Hilal
authors.initials: H
authors.lastname: Ince-Askan
authors.affiliation: Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: r.dolhain@erasmusmc.nl.
authors.forename: Radboud J E M
authors.initials: RJ
authors.lastname: Dolhain
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D003267:Contraception / Q000379:methods; D003376:Counseling / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D016742:Preconception Care / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Disease activity; Fertility; Lactation; Pregnancy; Rheumatoid arthritis