BACKGROUND:

The course of rheumatoid arthritis generally improves during pregnancy, but there are a significant number of patients who maintain active disease. In these cases, an increased risk of complications (first trimester abortions, prematurity, pre-eclampsia and restricted intrauterine growth) has been reported, as well as a higher probability of cesarean section.

CASE REPORT:

40-year-old patient, in the first pregnancy, with a previous diagnosis of rheumatoid arthritis in remission who managed to obtain her pregnancy after nine embryo transfers, maintaining treatment with glucocorticoids, hydroxychloroquine, and adalimumab. Pregnancy went without obstetric complications or outbreaks of rheumatoid arthritis. Treatment with hydroxychloroquine and adalimumab was withdrawn at week 20. Cesarean section was performed at week 39 due to failure of induction. A healthy newborn of 3095 grams was obtained, who did not require neonatal resuscitation or admission to the neonatal intensive care unit. Obtained an umbilical artery pH of 7.27 and Apgar 9/10. The puerperium passed without medical or obstetric complications.

CONCLUSION:

The planning of pregnancy is essential in women with rheumatoid arthritis, and should start in the period of remission of the disease. Obstetric complications are associated with pregnancies initiated in the active phase of rheumatoid arthritis. Treatment with low-dose glucocorticoids during the first phase of pregnancy (hydroxychloroquine, and anti-TNF biologic drugs) have shown maternal-fetal safety and efficacy in keeping the disease in remission.

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