In this Article, we will discuss the effect of those medications on the baby, which is whether they might cause any abnormalities in the baby; we call this whether or not they have a teratogenic effect.
Now we start with two very important pieces of information about rheumatoid and psoriatic medications and their effect on pregnancy in general:
First: Much of the available data on the effects of medications in general on pregnancy and outcome of pregnancy; meaning healthy babies versus babies with congenital abnormalities, are based upon maternal exposures. Less attention has been paid to the impact of those medications if men where the ones who were using them and how they affected the babies that they fathered.
Second: Effects of any medication on pregnancy outcome in humans will never come from research studies where some subjects will use the mediation and others will not, and then we compare the outcomes of pregnancies. This will never happen as this is not an ethical thing to do. Data come from reports of doctors who were seeing patients who used those medications and how those reports, over the years, from more and more doctors about more and more patients suggested or confirmed that a certain medication had some effect on the babies that were the outcome of those pregnancies.
So now we get into the heart of our subject. Rheumatoid and psoriatic arthritis medications and their effects on the born babies if fathers were using those medications
There are no medications that we know that are currently used for the treatment of rheumatoid arthritis or psoriatic arthritis that have proven teratogenic effects.
The situation is different in women of course. Some of the medications that are not teratogenic if used by men are very teratogenic if used by women. So, for effects in women, you should refer to Article addressing that particular topic and not rely on a Article addressing the effects in men.
With respect to teratogenicity if medications were used by men, medications are divided into three broad groups according to how confident we are about how safe those medications are to be used by men:
Group one:
medications that are generally presumed safe: here we mean that with the paternal use of those medications, the risk of congenital abnormalities to the baby does not exceed the 3 to 5 percent risk that is observed in the general population.
The medications in this category include the following:
Number 1: Methotrexate: Paternal exposure, I repeat: paternal, not maternal exposure to methotrexate around the time of conception, does not appear to have adverse consequences for pregnancy outcomes. I know you search on google and you might read about certain recommendations about methotrexate in particular that would make you worried. What you need to know here is that the recommendation you read about to stop methotrexate three months prior to conception is safe, but is not evidenced by an understanding of the impact of methotrexate on the process of sperm production or by an understanding of a confirmed or documented effect of methotrexate on the baby. It is just that the timeframe of sperm production is three months, so to be on the very safe side, some authorities advised to stop methotrexate for three months prior to pregnancy, that’s all.
Other medications in this group include:
Arava: this is the common brand name and its generic name is leflunomide: no data exist that suggest a teratogenic effect of arava when used by men.
Also salasopyrin, Imuran, all types of cortisone, neoral, plaquenil.
Also biological medications like enbrel, remicade, humira, Cimzia, Orencia and Mabthera.
Group two:
This is the limited evidence group: medications here are unlikely to be harmful but the data we have to prove this are rather limited.
Medications in this category include simponi, acterma, kevzara, cosentyx, taltz, stelara or Otezla.
Group three:
we don’t know. This is the we don’t know group which means that information regarding potential teratogenicity of those medications is unavailable. Those medications are too new on the market to know their possible effects on pregnancy
Medications in this group include the brand names xeljanz, olumiant, rinvoq and Smyraf.
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This post was prepared and published by Dr. Hatem Eleishi. Dr. Hatem Eleishi is a professor of rheumatology at Cairo university (Egypt) and is especially dedicated to supporting arthritis patients with online educational videos and articles about arthritis causes and treatment. He also runs a rheumatology clinic in Cairo and a center for www.tabibakom.com/en that, in addition to providing online rheumatology consultations, also provides online medical consultations in several different medical specialties by expert consultants from Egypt, Canada and the United States.
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