This sheet is about exposure to abatacept in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider.
What is abatacept?
Abatacept is a medication that has been used to treat rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), and psoriatic arthritis (PsA). It has also been used to treat COVID-19 in some hospitalized patients. It works by lowering the activity of T cells (part of the body’s immune system) to help reduce inflammation or swelling. It can be given through a vein in the arm (infusion) or by a shot under the skin. It is sold under the brand name Orencia®.
To learn more about rheumatoid arthritis and psoriatic arthritis, please see the MotherToBaby fact sheets at https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/ and https://mothertobaby.org/fact-sheets/psoriasis-and-pregnancy/. To learn more about COVID-19, please see the MotherToBaby fact sheet at https://mothertobaby.org/fact-sheets/covid-19/.
Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.
I am taking abatacept, but I would like to stop taking it before becoming pregnant. How long does the drug stay in my body?
People eliminate medications at different rates. In healthy adults, it takes up to 10 weeks, on average, for most of the abatacept to be gone from the body.
I take abatacept. Can it make it harder for me to get pregnant?
Studies have not been done to see if abatacept can make it harder to get pregnant.
Does taking abatacept increase the chance of miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. The manufacturer did not find a higher chance of miscarriage among 151 people who used abatacept in pregnancy.
Does taking abatacept increase the chance of birth defects?
Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Animal studies done by the manufacturer did not show an increased chance of birth defects when abatacept was used in pregnancy. Abatacept has not been well studied in human pregnancy. However, published information collected on over 200 pregnancies did not find a pattern of birth defects associated with abatacept use in pregnancy. There is also a case report of a woman with active rheumatoid arthritis who became pregnant while using abatacept, with her last dose just after the fourth week of pregnancy. She delivered a healthy infant that was also reported to be doing well at a 3.5-year follow-up visit. Based on limited information, there is probably not an increased risk for birth defects with abatacept.
Does taking abatacept in pregnancy increase the chance of other pregnancy related problems?
Studies have not been done to see if abatacept increases the chance for pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth).
Does taking abatacept in pregnancy affect future behavior or learning for the child?
Studies have not been done to see if abatacept can cause behavior or learning issues for the child.
Breastfeeding while taking abatacept:
Abatacept has not been well studied for use while breastfeeding. Since it is a large molecule, it is thought to be unlikely to enter the milk in high amounts. Also, abatacept is poorly absorbed from the gut, so it is unlikely that any of the medication the baby swallowed in the breast milk would be absorbed into the baby’s system. Be sure to talk to your healthcare provider about all of your breastfeeding questions.
If a male takes abatacept, could it affect fertility or increase the chance of birth defects?
Studies have not been done to see if abatacept could affect male fertility (ability to get partner pregnant). The manufacturer reported on 10 males who were taking abatacept when their partners became pregnant and did not find a greater chance for birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures (https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/).
MotherToBaby is currently conducting a study looking at abatacept and other medications used to treat autoimmune diseases in pregnancy. If you are interested in taking part in this study, please call 1-877-311-8972 or sign up at https://mothertobaby.org/join-study/.
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OTIS/MotherToBaby encourages inclusive and person-centered language. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Use of the term mother or maternal refers to a person who is pregnant. Use of the term father or paternal refers to a person who contributes sperm.
