The Interplay Between Rheumatoid Arthritis and Pregnancy Outcomes: A Narrative Review.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that commonly affects women during their reproductive years. With increasing use of disease-modifying therapies and greater emphasis on pregnancy planning, it is essential to understand how RA and its treatment impact pregnancy outcomes. This narrative review explores the pathophysiological changes of RA during pregnancy, evaluates maternal and fetal outcomes, examines the safety of RA medications, and highlights the importance of preconception counseling and coordinated care. A range of studies published between 2015 and 2025, including cohort studies, population-based registries, and prospective clinical research, were reviewed. These studies addressed immunological and hormonal changes during pregnancy, obstetric and neonatal risks, and safety profiles of various RA treatments. Pregnancy induces immune and hormonal shifts that often lead to reduced RA symptoms in the second and third trimesters, though disease flares are common after delivery. Despite improved therapies, women with RA remain at higher risk for complications such as miscarriage, preeclampsia, gestational diabetes, and cesarean delivery. Infants born to mothers with RA are at increased risk of preterm birth, low birth weight, and small-for-gestational-age status. Certain medications, like methotrexate, are unsafe in pregnancy and should be stopped in advance, while others, such as hydroxychloroquine and tumor necrosis factor (TNF) inhibitors, are considered relatively safe. Although RA presents significant challenges during pregnancy, favorable outcomes are possible through preconception planning, disease control, and multidisciplinary care. Continued research and personalized treatment strategies are essential to improve reproductive outcomes in women with RA.