Do you stop TNF inhibitors during the third trimester of pregnancy?

TNF inhibitor use in pregnancy is a common topic I review with patients. I make sure I include family members in my medication safety talks as well as provide tangible information, because unfortunately in the US there is a harmful stereotype that medications taken in pregnancy are bad and pregnant persons who need to take medications in pregnancy feel guilty about this. I try to dispel these myths and focus on the positive outcomes a rheumatic disease being controlled provides mom and baby. These include things like: decreased miscarriage and stillbirth, decreased pre-eclampsia, and less likely to have a preterm delivery. Hopefully it also prevents disease flares after delivery.

All TNF inhibitors are not the same. I do not stop certoliz...

While the ACR reproductive guidelines suggested discontinuation of many TNF-blockers during the third trimester, this is based on the risk of immunosuppression in the infant. The data from the inflammatory bowel disease literature suggest that these medications can be continued in many patients through delivery and during the postpartum period. We also know that increased inflammatory arthritis activity can portend poor pregnancy outcomes. Thus, for many patients, I will continue TNF inhibitors during delivery and the postpartum period, not just certolizumab.