Treating During Pregnancy (11.14.2025)
Dr. Jack Cush reviews the journal articles, news and guidelines from this past week on RheumNow.com
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Postmenopausal women on estrogen hormone therapy (HT) had a modest incr risk (HR 1.33; 1.32-1.35; P < .001). of a new autoimmune Dz over next 5-10 yrs (vs those not on HT) TriNetX study of 889,413 HT vs 2,6 mill (not HT) - 6.7% vs 5.3% developed autoimmune dz at 5 yrs. https://t.co/fsi32XIzLe
Dr. John Cush @RheumNow( View Tweet )
+ANA's are common in pregnancy. Study of 2159 Chinese 1st trimester pregnant women found ANAs positivity in 14.7 % (1:100 most common titer; speckled most common pattern). ANA+ assoc w/ smoking, age 30-34 yrs, multiparity, thyroid Dz & hypertension https://t.co/mRQGajVe3g https://t.co/DqE1KC4Kgo
Links:
Dr. John Cush @RheumNow( View Tweet )
Swedish Birth Registry study of adverse preg outcomes (APOs) after SSc Dx [n=941] or w/in 3 yrs [39] or > 3yrs pre-Dx [839]. SSc women have incr APOs post-Dx, including preeclampsia (RR 3.8), preterm (3.3), C-section (2.5); but also incr APO risk w/in 3 yrs of Dx
Dr. John Cush @RheumNow( View Tweet )
Systematic review of 10 studies showed TNFi exposure in utero not assoc w/ incr risk of infant severe infxn (4 RCTs); same for breast milk exposure (2 RCTs).
Infant vaccination outcomes unaffected by TNFi use, but rec delaying BCG vaccination if TNFi exposed https://t.co/02Nn6TuzR3
Dr. John Cush @RheumNow( View Tweet )
Using AI and LLMs in Qualitative Data
Dr. Bella Mehta discusses abstract 0794 (Using AI to Analyze Multilingual Qualitative Data in Lupus Pregnancy Research: A Proof of Concept with Large Language Models) presented at #ACR25
https://t.co/HFBuNxdZOF https://t.co/gKAXURq8xR
Dr. John Cush @RheumNow( View Tweet )
Marketscan claims study of 62,813 IMID women w/ 70,529 pregnancies & 69,412 births, 4,485 (7.1%) were exposed to at least one TNFi during pregnancy & 3,559 postpartum. TNFi use NOT assoc w/ SIE risk during Preg (HR 1.39; 0.95-2.05) or postpartum (HR 1.22; https://t.co/NsxOLpT0ds
Dr. John Cush @RheumNow( View Tweet )
🍼 “Stop breastfeeding if on methotrexate” — that’s what we’ve always heard.
But here’s the news 👇
📊 Latest EULAR lactation: Methotrexate = LoE 4 / C
➡️ May be considered in breastfeeding if no safer alternative exists.
💡Not first-line, not forbidden — just evidence-limited. https://t.co/IJEpZYMaFV
Dr Abhilasha Manwatkar (AIIMS Nagpur) @Abhilasha21822( View Tweet )
Really great visual summaries by Athena Chin, Sam Whittle and colleagues: Recs for the Use DMARDs in Pregnancy and Reproductive Health for Pts w Rheumatic Disease: A Scoping Review - Oct 2025 - Arthritis Care & Research #Rheumatology #MedEdu https://t.co/zRJcTESJWN 🇦🇺 https://t.co/OYZVtLEYr7
Links:
Suleman Bhana, MD @DrBhana( View Tweet )
New Insights into Pregnancy Outcomes and Maternal-Fetal Health in Rheumatic Diseases
At #ACR25, the ACR presented new research illuminating critical challenges and advances in pregnancy outcomes for women living with rheumatic diseases, including axial spondyloarthritis, https://t.co/nJjtTMHnD3
Dr. John Cush @RheumNow( View Tweet )
Abstract 2360: Single-center lupus pregnancy cohort found that:
🔹 Absence of DORIS remission associated w/ adverse pregnancy outcomes (Pre-term, Pre-eclampsia)
🔹 This is along with known risk factors: antihypertensive use, prior nephritis, active disease
@RheumNow #ACR25 https://t.co/STg1NBeFPo
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
Reaadmissions in sle pregnancies from 66k patients
Insurance and economics seem to be very important in predictions using machine learning.
Abst#2629 #ACR25 @RheumNow https://t.co/x2oo9TOxoh
Bella Mehta @bella_mehta( View Tweet )
In healthy women, preeclampsia was more common with:
- increased calprotectin
- decreased anti-CCP (very low levels)
during pregnancy
& this has good predictive capacity for future preeclampsia. Rheum pathophys can give insights into adjacent pathology
#ACR25 ABST2628 @RheumNow https://t.co/7d5YB6n6XJ
Links:
David Liew @drdavidliew( View Tweet )
Anti ccp may be protective for preeclampsia (secondary to NETs)
Abst#2628 @RheumNow #ACR25 https://t.co/n3ge0iIiB0
Links:
Bella Mehta @bella_mehta( View Tweet )
DMARD exposure overall during pregnancy is not associated with severe maternal or neonatal morbidity, in this Ontario cohort.
We’re getting better at finding a balance with DMARDs that is safe for both mother and baby. Blanket resistance is harmful
#ACR25 ABST2627 @RheumNow https://t.co/oDOpySGS3N
David Liew @drdavidliew( View Tweet )
Large Canada ICES dataset- DMARD use is not associated with adverse pregnancy outcomes. In pts with RA, SlE and other rheumatic diseases.
Abst#2627 #ACR25 @RheumNow https://t.co/T9Ll1FNjT7
Links:
Bella Mehta @bella_mehta( View Tweet )
This cohort study from Ontario of 🚺w/axSpA
✳️GDM, antepartum hem, SMM (severe maternal morbidity) -⬆️ in axSpA
✳️Neonat complications-preterm birth
Factors assoc w/SMM- age, comorbidity, gestational age at delivery
Better strategies for maternal care
#ACR25 @RheumNow Abs2200 https://t.co/LrVzJLnvWe
Links:
sheila @RHEUMarampa( View Tweet )
#ACR25 Abstr#0855 Five extra patients were added to complete IMPACT Open Label Phase 2 trial of add-on Certolizumab in APS women + LAC+ve. Results stood: primary endpoint was met (adverse pregnancy outcome=19.6%; lower than 20% expected). Significant enough to adopt @RheumNow https://t.co/zhFVGYXiaU
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
A largely understudied area:
Impact of peri-menopause in PsA
Toronto Cohort 473pts, HRT 1.5%
Peri menopause =
increase DAPSA, TJC, SJC, FACIT-fatigue, HAQ
compared to pre- and post-menopause
No association w/ BMI, but with fatigue
Less impact when education level increases https://t.co/bSuGxZCbGn
Links:
Aurelie Najm @AurelieRheumo( View Tweet )
In the IMPACT trial (Abs 0855), certolizumab met its primary endpoint: <20% had an adverse pregnancy outcome (APO) among females w/ APS & prior APO.
✅ 94% live births, all survived to discharge
📈 Median GA: 37 wks (no APO) vs 31 wks (APO)
@RheumNow #ACR25
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
Pregnancy risk in Sjögren’s & scleroderma
Meta-analysis (n=4,820) shows ↑ risk of miscarriage in Sjögren’s (RR 1.8) & ↑ preterm birth in SSc (RR 2.4).
Calls for preconception counseling & multidisciplinary high-risk OB care.
@RheumNow #ACR25 Abstract #1398
Jiha Lee @JihaRheum( View Tweet )
#0853 Olink proteomics in anti-Ro+ pregnancies identifies macrophage-derived IL-6 & CCL3 as serum predictors of foetal AV block
These pro-inflammatory proteins predicted fAVB independent of maternal diagnosis or Ab titres, pointing to new pathogenic pathways. @RheumNow #ACR25
Mrinalini Dey @DrMiniDey( View Tweet )
#0793 In #SLE, abusive trauma was linked to 58% higher risk of medication non-adherence; resilience buffered this effect. Patients with trauma cited motivational, not access-related, barriers. Trauma-informed & resilience-focused care may improve adherence. @RheumNow #ACR25
Mrinalini Dey @DrMiniDey( View Tweet )
#0794 LLMs can accelerate qualitative lupus pregnancy research. Using AI to translate & analyze interviews from Portuguese, GPT-4 achieved top accuracy & coherence vs human themes. LLMs may expand inclusion & equity in rheum research. @RheumNow #ACR25 https://t.co/TAxg6Qyk0L
Mrinalini Dey @DrMiniDey( View Tweet )
For #SLE pleuropericarditis: recommendation intentionally tries to leverage use of colchicine/NSAIDs vs. GCs
But there are special situations where GCs are req’d:
> Concomitant active SLE
> CI to NSAIDs/Col
> Recurrent pericarditis
> Late pregnancy
> 💊interxns
#ACR25 @RheumNow https://t.co/sLL72t3Qhf
Links:
sheila @RHEUMarampa( View Tweet )
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