Fertility and Birth Outcomes in Rheumatoid Arthritis: A Narrative Review

Rheumatoid arthritis (RA) is a systemic rheumatic disease that often impacts women of childbearing age. Women and men with RA experience higher rates of subfertility compared to the general population. Disease activity, treatment, psychosocial concerns, and sexual dysfunction contribute to subfertility, delayed childbearing, and reduced family size in the RA population. Assisted reproductive technology (ART) procedures are safe and effective options for patients who experience subfertility or are interested in preserving future fertility while continuing pregnancy-incompatible medications. Women with RA also experience increased risk of various adverse pregnancy outcomes compared to the general population, including preterm delivery and having small-for-gestational-age infants. Achieving well-controlled disease on pregnancy-compatible medications prior to conception optimizes maternal and neonatal outcomes. For patients with childbearing potential taking teratogenic medication, contraception is important; there are no RA-specific contraindications to the use of hormonal birth control. Sexual and reproductive health care for women and men with RA requires a multidisciplinary, patient-centered approach. Future studies are needed to elucidate mechanisms of impaired fertility and adverse pregnancy outcomes in RA, to investigate the safety of non-tumor necrosis factor inhibitor biologic disease‑modifying antirheumatic drugs (non-TNFi bDMARDs) during pregnancy and lactation, and to illuminate patient perspectives and priorities regarding their reproductive health across the lifespan.