This was published recently in the ACR conference:

Pregnancy Outcome in Women Exposed to Anti-TNF-alpha Medications: The
OTIS Rheumatoid Arthritis in Pregnancy Study
Category: 29 Epidemiology
Christina D. Chambers, Diana L. Johnson, Kenneth Lyons Jones, The OTIS
Collaborative Research Group. University of California, San Diego, San
Diego, CA
Presentation Number: 1224
Poster Board Number: 46
PURPOSE: Anti-tumor necrosis factor-alpha (anti-TNF-alpha)
medications, which are used to treat a variety of autoimmune
disorders, have not been well studied with regard to safety for a
developing fetus. A recent survey of members of the American College
of Rheumatology suggests that this lack of data results in poor
consensus regarding the use of these medications in pregnancy.
METHODS: Between 1999 and 2004, the OTIS Rheumatoid Arthritis in
Pregnancy Project prospectively followed 32 pregnant women with first
trimester exposure to either etanercept (n = 29) or infliximab (n =
4), all of whom were treated for rheumatoid arthritis and none of whom
used methotrexate. We compared pregnancy outcome in the anti-TNF-alpha
group to 77 women with rheumatoid arthritis who did not use any
anti-TNF-alpha medications (RA Controls), and 50 women without RA
(Non-Diseased Controls), all of whom were prospectively followed in an
identical manner.
RESULTS: Three women (1.9%) were lost to follow-up and two (1.3%)
terminated their pregnancies, one with etanercept exposure in a
pregnancy not known to be abnormal, and one in the RA Control group
following prenatal diagnosis of a chromosomal anomaly. In the
remaining 155 pregnancies, spontaneous abortion occurred in 3/28
(10.7%) of the etanercept-exposed women, 1/4 (25%) of the
infliximab-exposed women, and 5/74 (6.8%) and 2/49 (4.1%) of the RA
Control and Non-Diseased Control groups respectively (p = 0.36). The
only major structural defect that was reported in the anti-TNF-alpha
group was a chromosomal anomaly, Trisomy 18, which occurred in an
etanercept-exposed pregnancy that ended in spontaneous abortion.
Including liveborn infants, spontaneous abortions and terminations,
the overall rate of malformations in the anti-TNF-alpha group (1/33 or
3.0%) was similar to the proportion of major malformations (4.0% and
4.1%) in the two control groups respectively. Preterm delivery was
significantly more common in the anti-TNF-alpha group and in the RA
Control group relative to Non-Diseased Controls: etanercept 7/25

(28.0%); infliximab 2/3 (66.7%); RA Controls 16/68 (23.5%);
Non-Diseased Controls 2/47 (4.3%) (p<0.01). Mean birth weight in full
term infants was also significantly lower in the anti-TNF-alpha group
(3155 gm ± 517) and the RA Control group (3285 gm ± 401) relative to
Non-Diseased Controls (3585 gm ± 421; p <0.001). Findings regarding
both preterm delivery and growth remained statistically significant
after adjustment for potential confounders in multivariate analysis.
CONCLUSIONS: These preliminary data suggest that the rate of major
structural defects in the anti-TNF-alpha group is consistent with
population rates, and that the increased risks for preterm delivery
and poor growth in the offspring of women with rheumatoid arthritis
are likely to be attributable to the underlying maternal disease
and/or the concomitant use of systemic steroids.
Commercial Relationship:   C.D. Chambers, Abbott Laboratories 2; Amgen
5; D.L. Johnson, None; K.L. Jones, Aventis Pharmaceuticals 2; Abbott
Laboratories 2; Amgen 5.

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Amy, it is so good to see you again! We share in your excitement over this
pregnancy and I wish you nothing but the best with your new little one.

My relief with pregnancy was almost immediate, but at that time I was only
taking Azulfidine and gold, which I had to stop. I also didn't have any
morning sickness, so it sounds like my experience was a lot different than
yours.

I don't know of any studies with Enbrel and pregnancy...why don't you call
Amgen and ask if any have been done and what they recommend. Maybe you could
start using it again after the first trimester. Or maybe by then you won't
need it.:o)

Anyway, good luck with everything and best wishes for you and your growing
family.

Kelly C.;o)

Amy,

Just wanted to tell you how happy I am for you with the pregnancy. I wish
you the best of luck.

I hope that the RA stuff is just from this storm stuff going thru right now.
I hope  that you will be able to continue with some kind of pain control.

I won't tell you how long my morning sickness went on. But I will tell you
it does get better. Most people have it just during the first three months.
That is what I have heard anyways.
HOpe it gets over for you soon.

Eating dry crackers helps. If you eat a couple before you get up out of bed
in the morning.

Well I didn't get any remission with my last pregnancy 16 months ago, in
fact by the end I was worse than ever because I couldn't even take my
ibuprofen as you cant take in the last few months of pregnancy.
I'm 20 weeks with this current baby and so far also no remission
although my flares are staying in my feet, hands and wrists and I
haven't had any in my knees or neck so far.
What my Rheumy is doing this time, because I chose to come of my DMARDS
when I became pregnant, is just have me take the Brufen for pain as
needed and stop in the last weeks, and to come in for a Prednisone shot
when I'm feeling really sore. I had one large shot on wednesday and it
hasn't really kicked in yet so i'm hoping I start to get some relief by
the weekend.
As for the Embrel, we don't get it here in New Zealand, but I have US
friends who were on it right through pregnancy so I assume it's one of
those deemed ok if you really need it, which you sound like you do. It's
also ok to take when breastfeeding.
I'm not sure if you've experienced the post partum flare with your other
two, but watch out, it gets worse with each one, last time it hit at 5
weeks and I was a mess, I couldn't pick the baby up, couldn't stand,
couldn't raise my arms, couldn't even undo the poppers in the baby gro.
Make plans n preparation, have meds ready to go, an action plan and
help. See if you can make an appointment with your Rheumy that
co-incides with about 6-8 weeks after the birth so they can assess you
and give you any extra assistance over that rough spot.

Andrea

Here's a bit of my experience. I was on Enbrel until I was 6 weeks
pregnant. I did go off of it by my choice but was told I could take it
thru my first trimester.

There is a doc in Chicago who has been treating women with miscarriage
history with enbrel. If you google it wou will most likely be able to
find it (sorry I don't have much time or I would do it). Its hard to
explain so I will let you read about.

As for the sickness it is good to have morning sickness I was told it
means a nice strong pregnancy (but I sure wanted to pop the OB everytime
he said that to me). If it turns out to be all day sickness make sure
you get enough liquid. That's how my butt ended up in the hospital for
dehydration. There are also other options for nausea...reglan, phenegran
and Zofran...this is what I took.

I felt pretty good right away but I started out in a medicated remission
so that helped alot. I did have the post pregnancy flare from hell but
pretty much got that under control quickly.

I'm so happy for you, kiddo. I can only imagine how you guys must be
feeling. Joe and I were giggling the other day about when I was pregnant
with Hope I was so sick that I used to make him eat in the garage so I
wouldn't have to smell it...and the worst was when I couldn't watch
foodtv anymore since just seeing food on tv made me sick.

Hang in there, if you have any questions...hollar.

melissa
www.trowelfaz.com  for pics of Hope

The quesiness ended for me at about 11 weeks first pregnancy and 14 weeks
second time. As for Enbrel I breastfed for 2 1/2 years with no issues. As
for flares it was second baby's birth that kicked off the whole RA thing.
Feel better and congrats!

You can take pain medication while pregnant.  Opioids are safe if your
doctor is not afraid of them.   You can also take Prednisone.

You need to find a perinatologist who can handle your pregnancy not just a
regular ob/gyn.

I would not take any dmards while pregnant.

Nicole

http://www.arthritis.org/resources/arthritistoday/2001_archives/2001_03_04_Pregn
ancyPrognosis.asp
"

http://www.morningsicknesshelp.com/
Lots of great info here.

http://tinyurl.com/3j65d
B vitamins can sometimes help women with morning sickness.  It also helps to
strengthen your immune and nervous system.