Rheumatoid arthritis (hereinafter referred to as “rheumatoid arthritis”) is an autoimmune disease with chronic progressive joint lesions that can occur at any age, but 80% of the cases occur between the ages of 35 and 50, and are mostly seen in women, with a male to female ratio of about 1:3. Therefore, for a mother-to-be who suffers from wind-like pass, one doubt after another inevitably arises in her mind. Doubt 1: Will it affect my pregnancy? Will pregnancy make my condition worse? No. The disease itself has little effect on the ability to conceive, and in 54% to 90% of cases, the disease improves when the patient becomes pregnant. This is why many people say that “pregnancy can cure the disease”. However, unfortunately, almost all of the patients with P. aeruginosa have a relapse or worsening of the disease within 6 to 8 months after delivery (most relapses occur within 1 to 4 months after delivery). Therefore, despite the benefits of pregnancy for the disease, it is important to be cautious about getting pregnant. On the one hand, it can increase the risk of preeclampsia or hypertensive disorders of pregnancy, increase preterm labor and cesarean section rate; it can increase the risk of fetal distress and fetal growth restriction. Therefore, patients with rheumatoid arthritis should be evaluated by a specialist before planning a pregnancy. If the disease is active with severe extra-articular symptoms, such as fever, anemia, vasculitis, cardiopulmonary disorders, etc., pregnancy should be temporarily avoided and regular anti-rheumatic treatment should be received. On the other hand, the drugs used to treat rheumatoid arthritis have potential effects on the pregnant woman and her fetus, so pregnancy should be avoided only after sufficient time has elapsed since the drugs that have adverse effects on pregnancy have been discontinued. Doubt 2: What is the effect of rheumatoid drugs on the fetus? There are four main types of anti-rheumatic drugs used to treat rheumatoid arthritis: glucocorticoids, non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs and biological agents. To the best of our knowledge, the teratogenic effect of hormones is minimal; NSAIDs have a low risk of fetal congenital malformation and miscarriage when used in early pregnancy, and a risk of premature ductus arteriosus and other complications when used in late pregnancy. Therefore, rheumatoid off pregnant women, especially in early and late pregnancy, must strictly limit the use of NSAIDs and discontinue all NSAIDs 6 to 8 weeks before delivery, preferably at 32 weeks of gestation. Among the anti-rheumatic drugs to improve the condition, methotrexate and leflunomide should be prohibited during pregnancy because they can affect the fetus or lead to miscarriage; the teratogenic risk of salazosulfapyridine itself is very small, but it can inhibit the synthesis of folic acid and thus lead to fetal neural duct and cardiovascular development defects, oral malformations, etc. Therefore, folic acid should be routinely supplemented when salazosulfapyridine is used; the teratogenic risk of hydroxychloroquine is also very small. The teratogenic risk of biological agents such as etanercept, infliximab, adalimum, etc. cannot be determined because of the short time of marketing and few data on human pregnancy. Concern 3: If I am planning to have a baby, which of the drugs I am currently taking for the treatment of leptospirosis should I stop and for how long? Cytotoxic immunosuppressive drugs such as methotrexate and leflunomide must be discontinued before a patient with leukopenia becomes pregnant. Because methotrexate is widely deposited in tissues and accumulates in the liver for up to 116 days, it should be discontinued for at least 4 months prior to conception, along with folic acid supplementation until the end of pregnancy. The half-life of leflunomide is approximately 2 weeks and its active metabolites are involved in extensive enterohepatic circulation and take up to 2 years to clear. Therefore, it is not enough to stop the drug before conception in patients with leflunomide, but it is better to test the blood level before pregnancy, and if the blood level is ≥0.02 mg/L, the drug should be eliminated from the body by taking bilirubicin for 11 days. After that, the blood concentration should be rechecked at least 2 times at an interval of 2 weeks, and if the blood concentration is still not low enough, cholestyramine can be taken again. At least 3 menstrual cycles should elapse after discontinuation of biliamine before pregnancy can occur. Doubt 4: Do I need to take medication during pregnancy? What medications should I take? During pregnancy, some medications can be discontinued due to remission of the disease. If the symptoms are not completely relieved, small doses of hormones such as prednisone can be taken. Prednisone is mostly metabolized and inactivated by the placenta when it passes through the placenta, and the concentration in the fetus is very low, only equivalent to 10% of the maternal dose, thus it has little effect on the fetus. If hormones are used for a longer period of time, adequate calcium and vitamin D preparations should be supplemented. It is important to note that dexamethasone should not be used for hormonal control of wind-like symptoms in pregnant women during pregnancy, as it can reach high concentrations in the fetus due to its large percentage of transmission through the placenta. Dexamethasone is mostly used in pregnant women to treat fetal disorders, such as impaired lung maturation. In addition, high doses of hormones (equivalent to 1 to 2 mg of prednisone per kg of body weight per day) should be avoided during the first trimester because they may increase the risk of fetal cleft palate. Prolonged administration of hormones in the middle and late pregnancy can increase the incidence of gestational diabetes, hypertension, water and sodium retention, premature rupture of fetal membranes and osteoporosis. Doubt 5: Can I breastfeed after giving birth to my baby? No. Since the disease usually recurs within 1 to 4 months after delivery, especially in breastfeeding patients. Breastfeeding not only increases the risk of recurrence of rheumatoid arthritis in the mother, but also contains different concentrations of anti-rheumatic drugs in the breast milk, which can have adverse effects on the baby. Therefore, pregnant women with rheumatoid arthritis should be seen as soon as possible after delivery to understand their rheumatoid arthritis condition and develop a treatment plan, and to understand the effects of anti-rheumatic drugs on breastfeeding. Most NSAIDs can be used during breastfeeding, but they can increase the risk of neonatal jaundice and kernicterus. If required by the condition, it is best to use a drug with a short half-life (e.g., ibuprofen) or to switch to a low-dose hormone. Hormones may be secreted in minute amounts from breast milk and the amount of drug ingested via breast milk.