Background Rheumatoid arthritis (RA) tends to have its onset in women in their 40s or 50s, and not a few of these patients are still of childbearing potential. It used to be necessary to forgo pregnancy and delivery because of RA treatment, but with rapid advances in treatment drugs for RA, we have entered an era in which RA patients can become pregnant and deliver.
Objectives We conducted a survey to investigate actual conditions among RA patients who have experienced pregnancy and delivery, to consider the role of nurses in their treatment.
Methods Since biologics became available for RA treatment in Japan in 2003, our clinic has conducted interview-style questionnaire surveys of RA patients who have experienced pregnancy and delivery.
Results Seven of RA patients had experienced delivery. Two of the 7 RA patients had experienced delivery 2 times. and in all cases, both mother and child were normal. We now have 2 patients who are newly pregnant. The specific sources of anxiety concerning pregnancy and delivery included that the effects of RA treatment drugs on the fetus, the postpartum condition, advisability of use of RA treatment drugs while nursing, and effects of RA treatment drug while nursing on the newborn. On the other hand, they feel that they have sufficient understanding and cooperation from family members with respect to their pharmacotherapy during pregnancy and delivery. Before becoming pregnant, 5 of these patients had used etanercept (ETN), 1 had used infliximab, and 1 had used a steroid, and although 2 went drug-free after becoming pregnant, the other 5 continued to use the same treatment drugs they had used before becoming pregnant. All of the patients fed their babies with a combination of mother's milk and artificial milk, and 3 of them continued ETN monotherapy during the period of lactation.
Conclusions This survey elucidated the concerns of RA patients with respect to pregnancy and delivery. It shows the importance of having nurses address not only care of the disease itself but also total management entailing the building of relationships of trust with patients of reproductive age early on while providing mental care that includes the families, collaborating with departments of obstetrics, and collecting information, etc.
Disclosure of Interest None declared