This sheet is about exposure to abatacept in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.
What is abatacept?
Abatacept is a prescription medication that has been used to treat rheumatoid arthritis (RA; https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/), juvenile rheumatoid arthritis (JRA), and psoriatic arthritis (PsA; https://mothertobaby.org/fact-sheets/psoriasis-and-pregnancy/).
Abatacept is a protein that suppresses overly active T cells (part of the body’s immune system) to help reduce inflammation or swelling. It can be given in a healthcare provider’s office by intravenous infusion (through a vein in the arm) every 4 weeks, or once a week at home with a shot under the skin. It is sold under the brand name Orencia®.
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 this 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.
Talk with your healthcare providers before making any changes to this medication. The benefits of taking abatacept and treating your autoimmune condition during pregnancy need to be weighed against any possible risks of continuing the medication during pregnancy.
I take abatacept. Can it make it harder for me to get pregnant?
It is not known if abatacept can make it harder to get pregnant.
Does taking abatacept increase the chance for miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. The manufacturer did not find a greater chance for miscarriage among 151 women 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 for birth defects when abatacept was used in pregnancy. There is a small report from the manufacturer on 151 human pregnancies. This reported did not find a pattern of birth defects to be 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:
There have been no studies looking at the use of abatacept during breastfeeding. Abatacept is poorly absorbed from the gut, so it is unlikely that if any of the medication gets into breast milk that it would enter the baby’s system. It is possible that babies born before 37 weeks of pregnancy (premature) with digestive systems that are not fully developed would be able to absorb more of the medication in breast milk. Be sure to talk to your healthcare provider about all of your breastfeeding questions.
If a male takes abatacept, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?
The manufacturer had information on 10 males who were taking abatacept when their partners became pregnant and did not find a greater chance for birth defects. There are no other studies looking at possible risks to a pregnancy when a male takes abatacept. 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.