#2-98E. Evolving Guidelines: DMARDs, Pregnancy, and Reproductive Safety (Arthritis Care Res, 2025)

How do clinicians balance the critical need for maternal disease control with fetal safety in rheumatic diseases? This episode examines a 2025 scoping review that synthesizes 18 international guidelines published between 2014 and 2024 regarding the use of disease-modifying antirheumatic drugs (DMARDs) during pregnancy. The authors found that while recommendations for conventional synthetic DMARDs (csDMARDs) are largely consistent, guidance regarding biologic (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) varies significantly due to limited evidence. A vital clinical takeaway is the emerging trend permitting the continuation of TNF inhibitors, particularly certolizumab, throughout pregnancy, whereas newer agents like JAK inhibitors are generally avoided due to data scarcity. However, listeners must critically appraise these findings, noting that many guidelines rely on low-quality, retrospective observational data rather than robust trials, leading to heterogeneity in recommendations. Furthermore, guidance on male fertility and neonatal health remains notably insufficient. For physicians, this review is essential for navigating the complexities of current guidelines, enabling more informed decision-making and precise preconception counseling in an area where high-quality evidence is still developing.

Citation: Chin A, Terrett A, Kwon M, Whittle S, Hill C. Recommendations for the Use of Disease-Modifying Antirheumatic Drugs in Pregnancy and Reproductive Health for Patients With Rheumatic Disease: A Scoping Review. Arthritis Care & Research. 2025. DOI: 10.1002/acr.25558

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.