Which class of biologic DMARDs should be avoided in pregnancy?

• A. Non-TNFi biologics
• B. TNF inhibitors
• C. Rituximab
• D. IL-6 inhibitors

Answer: (A)

Biologic DMARDs differ in how safe they are for a developing fetus. The best-supported safety data come with TNF inhibitors, which are generally considered acceptable to use during pregnancy when needed, with careful monitoring. Non-TNFi biologics, by contrast, lack robust, consistent safety data in pregnancy and can affect fetal immune development, so they are typically avoided during pregnancy. For example, rituximab, a non-TNFi agent, crosses the placenta and can cause neonatal B-cell depletion, a concern that supports avoiding it in pregnancy. Other non-TNFi biologics carry similar uncertainties due to limited pregnancy outcome data. In short, non-TNFi biologics are the class to avoid during pregnancy.