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Management of pregnancy in women with rheumatoid arthritis

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Rheumatoid arthritis (RA) is a common condition which occurs more frequently in women than men.1 Its prevalence is about 2% in Australia, and this is predicted to increase to 3% by 2032.2 Therefore, the need to manage pregnancy in a woman with RA is not an uncommon clinical scenario. Clinicians must be aware of the teratogenicity of certain disease-modifying antirheumatic drugs (DMARDs) used to treat RA, and must ensure that women taking these drugs are using reliable contraception. Clinicians also have an important role to play in prepregnancy counselling to facilitate informed decision making. We,3 and others,4 have identified unmet information needs among women with RA, including needs relating to contraception, pregnancy planning, pregnancy and early parenting. The aim of our review is to highlight pertinent issues in managing pregnancy in women with RA.

Effect of RA on fertility and pregnancy

Despite having normal ovarian reserves,5 women with RA have fewer children than women in a control group,6 and take longer to conceive.7 The reasons for smaller family size have not been fully elucidated but may include personal choice, uncontrolled inflammatory disease, sexual dysfunction secondary to RA and the effects…