Which DMARD is considered an alternative treatment for RA in pregnancy or breastfeeding?

• A. Methotrexate
• B. Hydroxychloroquine
• C. Leflunomide
• D. Etanercept

Answer: (B)

Safety of a DMARD during pregnancy or breastfeeding depends on how well it protects the fetus and infant while still controlling the mother’s RA. Hydroxychloroquine has the most favorable and well-established safety profile for both pregnancy and lactation, so it’s the preferred option when a DMARD is needed during these periods. Methotrexate is clearly contraindicated in pregnancy because it is teratogenic and can cause fetal abnormalities or miscarriage. Leflunomide is also highly teratogenic and has a long half-life, requiring an extensive washout before conception. Etanercept has some supportive safety data in pregnancy, but hydroxychloroquine is generally favored due to its longstanding use and compatibility with breastfeeding, making it the best choice in this context.