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#Episode 15:

Arthritis & Pregnancy

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Episode Description:

Arthritis can strike at any time, including the childbearing years, for both females and males. Active arthritis is a risk factor for many pregnancy complications, including miscarriage and early labour.

Fifteen to 20 years ago, the advice was different. There was so little data on arthritis, medication safety and pregnancy that people living with rheumatic disease were advised not to get pregnant. Arthritis Research Canada’s scientists were the first to show that taking biologics during pregnancy, by a woman with arthritis, does not lead to complications like premature babies, low birth weigh, birth defects or infections in moms and infants.

A planned pregnancy is the best pregnancy. Ideally, women with arthritis should have low disease activity, or be in remission, and be on medications considered safe in pregnancy before trying to have a baby.

 Dr. Neda Amiri
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Episode Content:

In Episode 15 of the Arthritis Research Education Series, discover how our scientists are finding answers to help women, and their families, navigate pregnancy with arthritis.

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Content and Topic of Research

Arthritis Research Canada’s scientists were the first to show that taking biologics during pregnancy, by a woman with arthritis, does not lead to complications like premature babies, low birth weigh, birth defects or infections in moms and infants.

“We’ve entered an exciting era in arthritis treatment,” said. Dr. Mary De Vera, a senior scientist at Arthritis Research Canada. “But with that excitement, there are more questions.”

De Vera’s team is working to understand the long-term safety of biologics, as well as the safety of biosimilar use during pregnancy.

Pregnancy, Medication Safety and Parenting Research

Research Scientists

Dr. Neda Amiri, BSc, MD, MHSC, FRCPC

Rheumatologist & Clinician Investigator, Arthritis Research Canada

Dr. Neda Amiri is a Clinical Associate Professor in the Department of Medicine, Division of Rheumatology, at the University of British Columbia, and a Clinician Investigator with Arthritis Research Canada. Her research interests include pregnancy outcomes in patients with rheumatic diseases, and supporting positive pregnancy outcomes in this population.

Dr. Amiri started the Pregnancy and Rheumatic Diseases Clinic at the Mary Pack Arthritis Centre in 2017. This clinic is the first of its kind in British Columbia and assists patients with rheumatic diseases who are seeking counseling regarding conception, and follows their care in pregnancy.

2025-Mary-de-Vera-EDI-Grant-Release_Feature-Image_FINAL

Dr. Mary De Vera, MSc, PhD

Senior Scientist, Pharmacoepidemiology, & Associate Director of Training, Arthritis Research Canada

Dr. Mary De Vera is an Associate Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia and a Senior Scientist at Arthritis Research Canada. Her research interests include medication adherence and pregnancy in rheumatic diseases.

The overarching objective of Dr. De Vera’s research is to support and inform patient journeys in living with, and managing chronic disease. She has a productive research area focusing on two important problems related to medication use – medication adherence and medications in pregnancy, particularly in rheumatology/rheumatic diseases.

Additional Resources

Women living with inflammatory arthritis, and rheumatic diseases, who want to start families often have questions. Am I able to get pregnant? Will I pass my disease to my child? Do I need to stop taking my medications during pregnancy? What will happen to my disease once I’m pregnant? Will I experience arthritis flares after I give birth? Can I breastfeed my baby? Will I be able to raise my kids?

When it comes to arthritis and pregnancy, it’s important to start the conversation early. “A planned pregnancy is the best pregnancy,” said Dr. Neda Amiri, a rheumatologist and clinician investigator at Arthritis Research Canada. “I make a joke with our patients that, even before your partner, we should know if you are planning to have kids.”

If you are living with arthritis and considering pregnancy, explore some of the helpful resources on this page and use them to start a conversation with your rheumatologist.

“It’s a misconception that arthritis is an older person’s disease. Arthritis impacts whole families – the mother with arthritis, her unborn baby, her healthily born baby and her partner.”

Dr. Mary De Vera

Frequently Asked Questions

Is it possible to have children when living with inflammatory arthritis?

It is definitely possible to have inflammatory arthritis, or rheumatic disease, and still have a family and be pregnant. However planned pregnancy is the best pregnancy.

Talk to your rheumatologist. It’s ideal to achieve low disease activity or remission before pregnancy. Patients also need to be on pregnancy compatible medications. A lot of medications are safe to use in pregnancy and breastfeeding, but some are not. Some women will need to transition to pregnancy compatible medications before trying to conceive. Once someone is pregnant, doctors will then look at how the disease can impact the pregnancy, outcomes and how the pregnancy may impact the way the disease behaves.

Most rheumatic diseases do not affect fertility or a couple’s chances of becoming pregnant. The only exception is that some data has shown that it might take people who have rheumatoid arthritis or ankylosing spondylitis longer to get pregnant. We don’t understand all of the factors that play into that, but one of the concerns that has been raised is that too much use of anti-inflammatories, or what we call non-steroidal anti-inflammatory medication, such as ibuprofen, may impair ovulation and, therefore, chances of becoming pregnant. We also know that, for individuals living with lupus or connective tissue diseases, fertility is not affected but they may have higher chances of miscarriage.

Arthritis can strike during childbearing years for females and males and active arthritis is a risk factor for many adverse pregnancy outcomes or complications. Research has shown that, when a female is in flare, they are more likely to have a miscarriage. They are also more likely to go into labour early, and have babies with low birth weigh and birth defects. Moms and babies are also more likely to experience infections.

Using contraception is important for people living with rheumatic diseases because some medications are not safe to take during pregnancy. Therefore, contraception needs to be used to prevent unplanned pregnancies while taking these medications. Most contraceptives are safe for people living with rheumatic diseases. The exception to this is if someone has lupus, antiphospholipid antibody syndrome, or antiphospholipid antibodies, as some contraceptives are not recommended. Individuals should discuss contraceptive options with their rheumatologist, family physician or obstetrician.

It’s very hard to estimate an exact risk of passing down a disease, like rheumatoid arthritis, to an infant. Multiple factors determine whether a person will develop a rheumatic disease. Having a genetic predisposition is just one part of the equation. Environmental factors play a role. There is also the concept of epigenetics – how behaviours and environment affect the way genes work. So, even if a gene gets passed down, if it is turned off, it’s unlikely that it will cause concern. Rheumatologists often use the Swiss cheese model to explain risk. In order for someone to get a disease like rheumatoid arthritis, you have the first slice of cheese and it has some holes in it and maybe you have the gene. Then there is the next layer of cheese and it has different holes, for example, depending on whether you smoke. The next layer includes major life stressors. Did you get a virus that made your immune system go haywire? A lot of different things have to happen. Individuals with first-degree relatives with inflammatory arthritis are at a higher risk of developing that disease, but the vast majority of them do not.

We don’t know whether it infers a higher risk if that genetic risk, or genetic predisposition, comes from the father’s side or the mother’s side. We just know that, if you have a first-degree relative with an autoimmune disease, such as rheumatoid arthritis, your risk of having that disease is higher, probably two times that of the general population.

One of the more common medications used in rheumatology, that is not safe in pregnancy, is methotrexate. If someone is taking this medication, it needs to be stopped prior to conception. Once the medication is stopped, rheumatologists then observe to see if an individual flares without the drug. If they flare, it’s not ideal for them to become pregnant until inflammation is controlled. An alternate, pregnancy-safe medication then needs to be tested. Once on the new medication, a six-month observation period is recommended to make sure the new medication regimen is working and that the person is stable and doing well. There are other arthritis medications not considered safe in pregnancy, so individuals should talk to their rheumatologist before tying to get pregnant.

The vast majority of data, when it comes to men and arthritis medications, suggests that the medications a father is on does not have any impact on the developing baby. The only exception to this is if the man is on cyclophosphamide, which is used in severely sick patients with either autoimmune diseases or, in some instances, cancers. People taking this medication need to wait at least three months before trying to have a baby.

Pregnancy affects different diseases in different ways because of the immune shifts that can happen in pregnancy. For example, it is an old saying that “Every patient who has rheumatoid arthritis gets better in pregnancy.” It is true to an extent that, if someone has really high disease activity with 20-30 swollen joints, they will experience some improvement in pregnancy, However, taking arthritis medications that are safe in pregnancy is better than relying on the pregnancy effect alone. On the other hand, diseases like lupus can flare in pregnancy. There is a 10-30 per cent risk of people with lupus experiencing flares in pregnancy, and this is in individuals who go into pregnancy having a low disease state or being in remission. If someone goes into pregnancy with lupus, having moderate to high disease activity can be a recipe for disaster with worsening disease and much higher risk of flares.

When it comes to rheumatic diseases and medications in pregnancy, what we know for sure is that stopping medications cold turkey, or stopping them suddenly without having any alternative plan, is usually a recipe for disaster. Doing so will lead to a flare of the disease potentially in pregnancy and adverse outcomes for the mom and baby.

We know a lot of medications in the category of conventional, synthetic disease modifying anti-rheumatic drugs (DMARDs) are safe. So, this includes hydroxychloroquine, sulfasalazine, and azathioprine. These medications are safe in pregnancy and breastfeeding. Biologics are a relatively newer class of medications that have been around for about 20-25 years. We now have a lot of data when it comes to anti-TNF biologics and we know them to be safe and compatible throughout pregnancy and breastfeeding. When it comes to other biologics, we don’t have as much data to make strong recommendations/guidelines. Therefore, individualized discussions in terms of whether someone should continue their medications in pregnancy are needed. For the most part, biologics are continued during pregnancy.

The Pregnancy and Rheumatic Diseases Clinic is located at the Mary Pack Arthritis Centre in Vancouver. This clinic opened in 2017 and is a unique model in British Columbia, as it is the only clinic in the province where rheumatologists, family physicians and obstetricians can refer patients with underlying rheumatic diseases who are either pregnant or planning to become pregnant.

For patients who are not yet pregnant, clinic physicians meet with them prior to pregnancy and go through a pre-pregnancy checklist. That list includes things like disease state, medications, information about previous pregnancies and pregnancy outcomes and having a conversation about what needs to happen before proceeding with pregnancy.

If it is determined that it is not a good time to proceed, physicians make recommendations around what changes need to happen. If necessary, follow up is done to make sure an individual is in the optimal state. After someone is pregnant, the clinic follows them once every trimester in pregnancy, assuming they are doing well, sometimes with increased monitoring if they experience complications. Clinic physicians liaise with maternal fetal medicine specialists and obstetricians to work as a team of doctors for the patient.

After delivery, around the 2-3 month mark, physicians meet with women to see how delivery went, discuss any increased disease flares or symptoms, and review medications to ensure they are compatible with lactation or breastfeeding. The clinic also reviews infant immunization schedules, as women on some medications, especially biologics, may need to alter their infant’s vaccination times.

Absolutely.  A lot of arthritis medications are safe with breastfeeding and breastfeeding is encouraged.

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Helpful Links

Obesity Canada

Obesity Canada is the leading national organization dedicated to improving the lives of individuals living with obesity through advocacy, education, and research. Learn More

24-Hour Movement Guidelines

Canada’s first ever 24-Hour Movement Guidelines for Adults offer clear direction on what a healthy 24 hours looks like for Canadian adults aged 18-64 years and 65 years or older. Learn More

Just One Move

Good days start with one move. This resource seeks to empower people living with arthritis to stay active and do more of what they love. Learn More

I START Tool

The I START Tool was developed by Arthritis Research Canada scientists and is an education and conversation tool for co-developing muscle-strengthening exercise prescriptions for people with rheumatoid arthritis. Learn More

Canada’s Food Guide

Canada’s food guide is Health Canada’s guidance on healthy eating for people in Canada two years of age and older. Learn More

OsteoArthritis Service Integration System (OASIS)

OASIS is an education program that helps people with arthritis self-manage their condition. Learn More

2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis

These are guidelines on exercise, diet, and more, for people living with rheumatoid arthritis. Learn More

HealthLink BC 8-1-1 Services

Registered Dietitians at HealthLink BC can answer your healthy eating and nutrition questions. Dietitian services are available from 9am to 5pm, Monday to Friday, or you can email a dietitian. Learn More

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