Many women with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis require Anti-TNF medications to control disease activity. The key question is: Are these medications safe during pregnancy and breastfeeding?

First: Pregnancy

1️⃣ Certolizumab (Cimzia)

Cimzia (Certolizumab) is the least likely to cross the placenta and does not reach the fetus at clinically significant levels. Therefore, it is considered the preferred option during pregnancy.

2️⃣ Other Anti-TNF Medications

Humira (Adalimumab)

Enbrel (Etanercept)

Simponi (Golimumab)

Remicade (Infliximab)

These medications may cross the placenta, especially during the third trimester. However, large studies have not shown an increased risk of congenital malformations or major fetal complications.

🔹 Common recommendation: Stop the medication during the last 3 months of pregnancy to reduce its levels in the baby’s blood after birth.

🔹 In cases of high disease activity: Treatment may be continued until delivery, with postponement of live vaccines for the infant during the first 6 months of life.

Second: Breastfeeding

Very small amounts of Anti-TNF medications pass into breast milk, and they are not absorbed in significant amounts by the infant’s body.

Studies have not shown an increased risk of infections or growth problems in breastfed infants.

Conclusion

The decision is always a balance between:

✔️Controlling disease activity

✔️ Ensuring pregnancy safety

✔️ Following the latest scientific evidence

Treatment decisions are individualized and should be discussed between the rheumatologist, obstetrician, and pediatrician.