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A Canadian population-based study shows that pregnant women with rheumatoid arthritis (RA) frequently discontinue their DMARD medications, especially in the first trimester.
An administrative data study looked at women with RA with a singleton pregnancy who were studied for utilization of RA medications, including conventional synthetic DMARDs, biologics, glucocorticosteroids and NSAIDs.
Among 1730 pregnancies in 1301 RA women they observed substantial medication discontinuation. This was most notable in the first trimester, with the majority of RA patients discontinuing antimalarials (57.3%), azathioprine (59.1%), sulfasalazine (69.5%) and biologics (50.8%).
Discontinuation of antimalarials in the first trimester was associated with being multiparous, a higher discontinuations were seen with lower maternal age (OR 0.90; 95% CI 0.86, 0.95) and fewer rheumatology visits (OR 0.86; 0.75, 0.97). Biologic discontinuations were associated with prior adverse birth outcomes (OR 0.22; 0.05, 0.95).
The fact that RA patients frequently discontinue their DMARD and biologic medications once they become pregnant suggests a need to educate women with RA, who are planning pregnancy, on the risks of medications during pregnancy and which can be safely continued.