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Drug Info

Can you take Rinvoq while pregnant?

The effects of Rinvoq on pregnant animals are enough for healthcare providers to recommend alternatives for women who are pregnant
Wendy Wisner
By | Sep. 24, 2024 Medically reviewed by Leslie Greenberg, MD
A pregnant person looking at their belly: Can you take Rinvoq while pregnant?

Key takeaways

  • Rinvoq is a JAK inhibitor used to treat inflammatory and immune system conditions.

  • Most healthcare providers recommend against the use of Rinvoq during pregnancy or while breastfeeding.

  • There are no clinical trials on Rinvoq in humans during pregnancy, but studies on pregnant animals found an increased rate of birth defects, pregnancy loss, and low birth weights.

  • If you are looking for alternative medications to Rinvoq during pregnancy, reach out to a healthcare professional for medical advice.

In this article:

Rinvoq (upadacitinib) is a brand-name medication that’s approved by the Food and Drug Administration to treat rheumatoid arthritis, atopic dermatitis, active psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, and Crohn’s disease. Although it’s an effective treatment for many inflammatory and immune system conditions, there are important safety considerations to keep in mind if you’re pregnant or considering becoming pregnant.  

Let’s take a closer look at Rinvoq and pregnancy, including how it affects the pregnant person and baby, whether you can take Rinvoq while breastfeeding, and what alternative options are available for you during pregnancy.

Can you take Rinvoq while pregnant?

You should not take Rinvoq while pregnant. “Rinvoq is contraindicated during pregnancy and lactation,” says Kecia Gaither, MD, a double board-certified OB-GYN. Sazan Sylejmani, Pharm.D., shares Dr. Gaither’s point of view. “As a pharmacist with experience in rheumatology, I would not generally recommend Rinvoq during pregnancy,” he says.

The main reason Rinvoq is not recommended during pregnancy is that there isn’t enough data on its safety in humans. When data is lacking on a particular medication during pregnancy, clinicians typically do not recommend it. However, there is enough data that we can gather from animal studies.

Embryo-fetal development studies carried out in rats and rabbits found that when Rinvoq is taken during pregnancy, it causes birth defects and fetal abnormalities. However, it should be noted that, in some cases, the amount of Rinvoq given to these animals was more than the comparable human dose. Nonetheless, these adverse effects were enough to prompt AbbVie, the manufacturer of Rinvoq, to advise pregnant women not to take it during pregnancy. Many women have unintended pregnancies or do not know that they are pregnant at first. Because of these two reasons, Rinvoq should not be given to sexually active women who are not using contraception. 

What are the risks of taking Rinvoq while pregnant?

When taken by pregnant people, Rinvoq has the potential to directly and permanently impact an unborn baby. “Rinvoq is an immunosuppressant that can cross the placenta, posing risks to both the mother and fetus like serious infections,” Dr. Sylejmani says.

In animal embryo-fetal development studies, Rinvoq exposure caused:

  • Increased rates of skeletal malformations (in rats)
  • Increased incidences of cardiovascular malformations (in rabbits)
  • Increased rates of post-implantation loss (in rabbits)
  • Low fetal body weights (in rabbits and rats) 

It’s for these reasons that Abbvie not only advises against using Rinvoq during pregnancy but also recommends using effective birth control (contraception) while taking Rinvoq and for four weeks after your last medication dose. 

If you do become pregnant while taking Rinvoq, AbbVie requests that you report it to its pregnancy surveillance program by calling 800-633-9110. The purpose of the program is so AbbVie can collect information about the health of yourself and your baby, and to get a better understanding of how it affects pregnant humans. This information helps scientists give more informed human recommendations. 

Can you take Rinvoq while breastfeeding?

In general, most medications are safe to take during breastfeeding, according to the Centers for Disease Control and Prevention (CDC). Although most medications do pass into breast milk, most don’t have a negative impact on infants. However, there are exceptions, and mothers should connect with their providers to weigh the risks and benefits of any given medication during breastfeeding.

Similar to Rinvoq during pregnancy, very little is known about the impact of Rinvoq on breastfeeding, including how it might affect breastfeeding infants or breast milk supply. “For lactating mothers, very little Rinvoq passes into breast milk, but risks still exist,” Dr. Sylejmani said.

LactMed, a breastfeeding and medication database sponsored by the National Library of Medicine, states that there is no data on the use of upadacitinib (Rinvoq) and breastfeeding. But, the majority of sources it considered do not recommend that mothers breastfeed their infants while using Rinvoq. This is especially true if you are nursing a newborn or a preterm baby.

The manufacturer’s medication guide states that Rinvoq may pass into breast milk and that if you are discontinuing Rinvoq and want to breastfeed, you should wait at least six days between stopping Rinvoq and feeding your baby breastmilk.

What can I take instead of Rinvoq during pregnancy?

If you’re pregnant or thinking about becoming pregnant and are in need of treatment for one of the conditions Rinvoq treats, there may be safer alternatives for you to consider. “It’s best to work with a rheumatologist on alternatives, pending your diagnosis, on what’s best during pregnancy and lactation,” Dr. Gaither suggests.

When it comes to rheumatoid arthritis treatments during pregnancy, the options are limited. “Low-dose corticosteroids or hydroxychloroquine may be options, depending on the patient,” Dr. Sylejmani explains. “In any case, risks and benefits must be weighed carefully for each individual in consultation with their doctors.”  

According to the Arthritis Foundation, the following alternatives may be options for you to consider if you have rheumatic disease and are pregnant:

As for breastfeeding, the Arthritis Foundation recommends these drugs as safer medications to consider during lactation:

  • TNF blockers
  • Hydroxychloroquine
  • Colchicine
  • Sulfasalazine
  • Prednisone, but at a dose lower than 20 mg daily

Managing medication for rheumatic disease and other related conditions during pregnancy and lactation can be tricky. But there are options out there for you. “Communication between patient, rheumatologist, and OB-GYN is key to navigating this complex situation,” Dr. Sylejmani says.

Use contraception diligently and plan your pregnancies. 

Make sure to stay in close touch with your healthcare provider if you have any further questions about Rinvoq and pregnancy. Always contact a healthcare professional if you notice any serious side effects or allergic reactions from a prescription drug you are taking.

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