Guideline Recommendations for DMARD Use in Pregnancy Show Significant Variability

Published in Arthritis Care & Research, a new scoping review highlights ongoing challenges in managing disease-modifying antirheumatic drugs (DMARDs) during pregnancy and reproductive health for patients with autoimmune rheumatic diseases. 

The review evaluated 18 guidelines published since 2014 from academic rheumatology societies, focusing on rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and systemic lupus erythematosus. Among these, 56% addressed DMARD use in preconception, 67% in lactation, and 33% in male fertility. Notably, 72% of guidelines included recommendations for csDMARDs and bDMARDs, while only 28% addressed tsDMARDs.

"There is heterogeneity in formulation of guidelines on the use of DMARDs in pregnancy," the authors reported. They noted that "recommendations for csDMARDs were similar between guidelines," supported by moderate evidence, whereas "there was significant variability in recommendations for b/tsDMARD use, reflecting current minimal literature in this area."

The findings underscore the need for individualized patient care, particularly when managing bDMARDs and tsDMARDs around pregnancy and lactation. The lack of consistent recommendations for these newer agents highlights a critical gap in evidence-based guidance and points to an urgent need for further research, the authors stated.

Clinicians must remain vigilant, balancing disease control with reproductive safety, and carefully interpreting existing guidelines when advising patients of childbearing potential.

Reference
Chin A, Terrett A, Kwon M, Whittle S, Hill C. Recommendations for the use of DMARDs in pregnancy and reproductive health for patients with rheumatic disease: A scoping review. Arthritis Care Res (Hoboken). Published online April 21, 2025. doi:10.1002/acr.25558