Use of DMARDs in women with RA of childbearing age: practice patterns and pregnancy outcomes

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J Rheumatol. 2003 Feb;30(2):241-6.

The use of disease modifying antirheumatic drugs in women with

rheumatoid arthritis of childbearing age: a survey of practice patterns

and pregnancy outcomes.

Chakravarty EF, -Yamamoto D, Bush TM.

Division of Immunology and Rheumatology, Department of Medicine,

Stanford University School of Medicine, Stanford, California, USA.

OBJECTIVE: To describe the practices of rheumatologists when prescribing

the disease modifying antirheumatic drugs (DMARD) methotrexate (MTX),

leflunomide (LF), etanercept (ET), and infliximab (IN) to women of

childbearing age with rheumatoid arthritis (RA) and the pregnancy

outcomes of patients who become pregnant while taking these medications.

METHODS: A questionnaire was mailed to 600 members of the American

College of Rheumatology inquiring about their perception of fetal risk,

their recommendations regarding the use of birth control in women of

childbearing age taking DMARD, and the pregnancy outcomes of women with

DMARD exposure. RESULTS: One hundred seventy-five rheumatologists (29%)

returned completed surveys. Respondents were more likely to agree that

pregnancy is contraindicated in women taking MTX (95%) or LF (92.7%)

than for women taking ET (38.6%) or IN (46.5%). Accordingly, most

required birth control for women taking MTX (95.7%) and LF (97.3%), and

fewer for women taking ET (75.4%) or IN (73.4%). A total of 65

pregnancies exposed to these DMARD were reported (MTX 38, LF 10, ET 14,

IN 2, MTX and ET 1). Only 3 congenital malformations, all in the MTX

group, were reported among the 52 pregnancies with known outcomes.

CONCLUSION: Rheumatologists agree that there is a risk of teratogenicity

with MTX and LF and usually require the use of reliable methods of birth

control in women taking these medications. There is no consensus about

ET and IN; however, physicians still tend to discuss reliable birth

control methods with their female patients. We have confirmed there is a

risk of congenital malformations with in utero exposure to MTX. No

malformations were reported in infants exposed to LF, ET, or IN, but the

number of reported pregnancy outcomes was small.

PMID: 12563675

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