{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:30:12Z","timestamp":1772721012108,"version":"3.50.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare of Japan","doi-asserted-by":"publisher","award":["22FE1002"],"award-info":[{"award-number":["22FE1002"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To inform the 2024 updates of the Japanese College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis of the safety of maternal and paternal exposure to disease-modifying antirheumatic drugs (DMARDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched the databases of PubMed, the Cochrane Library, and the Japana Centra Revuo Medicina for articles published between 2019 and 2022 and combined them with our previous systematic review. Two independent reviewers screened articles, evaluated core outcomes, and performed meta-analyses for each clinical question.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The relative effects (odds ratio (OR) [95% confidence interval (95% CI)]) of tumour necrosis factor inhibitor (TNFi) exposure on the infants of pregnant women with rheumatoid arthritis were as follows: major birth defects, 1.51 [0.89, 2.58]; and serious neonatal infections, 1.20 [0.84, 1.71]. The relative effects (OR [95% CI]) of paternal antirheumatic drugs exposure on major birth defect in infants were 1.30 [0.28, 6.14] for TNFi and 0.94 [0.38, 2.33] for methotrexate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This systematic review provided the latest evidence on effects of maternal and paternal exposure to DMARDs on their infants for the 2024 update of the clinical practice guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/mr\/roaf087","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T12:09:10Z","timestamp":1759925350000},"page":"181-189","source":"Crossref","is-referenced-by-count":0,"title":["Systematic review of the treatment of rheumatoid arthritis patients of reproductive age: informing the 2024 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis\u2014secondary publication"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5569-9275","authenticated-orcid":false,"given":"Mikako","family":"Goto","sequence":"first","affiliation":[{"name":"Japan Drug Information Institute in Pregnancy, Integrated Center for Women's Health, National Center for Child Health and Development , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1763-6462","authenticated-orcid":false,"given":"Chie","family":"Kohno","sequence":"additional","affiliation":[{"name":"Japan Drug Information Institute in Pregnancy, Integrated Center for Women's Health, National Center for Child Health and Development , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chinatsu","family":"Takai","sequence":"additional","affiliation":[{"name":"Japan Drug Information Institute in Pregnancy, Integrated Center for Women's Health, National Center for Child Health and Development , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5785-1852","authenticated-orcid":false,"given":"Eiko","family":"Miyagawa","sequence":"additional","affiliation":[{"name":"Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3118-7675","authenticated-orcid":false,"given":"Ryo","family":"Yanai","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Showa Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8292-3962","authenticated-orcid":false,"given":"Nobuyuki","family":"Yajima","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Showa Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2646-5765","authenticated-orcid":false,"given":"Yuko","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2850-326X","authenticated-orcid":false,"given":"Eiichi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Tokyo Women's Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3860-0488","authenticated-orcid":false,"given":"Yutaka","family":"Kawahito","sequence":"additional","affiliation":[{"name":"Department of Inflammation and Immunology, Kyoto Prefectural University of Medicine , Kyoto ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6418-2603","authenticated-orcid":false,"given":"Masayoshi","family":"Harigai","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Tokyo Women's Medical University School of Medicine , Tokyo ,","place":["Japan"]},{"name":"International University of Health and Welfare School of Medicine , Chiba ,","place":["Japan"]},{"name":"Sanno Medical Centre , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3411-5896","authenticated-orcid":false,"given":"Kayoko","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development , Tokyo ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"2026030508171940300_ref1","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.3899\/jrheum.140583","article-title":"Disease severity and pregnancy outcomes in women with rheumatoid arthritis: results from the Organization of Teratology Information Specialists Autoimmune Diseases in pregnancy project","volume":"42","author":"Bharti","year":"2015","journal-title":"J Rheumatol"},{"key":"2026030508171940300_ref2","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1002\/acr.23730","article-title":"Factors associated with preterm delivery among women with rheumatoid arthritis and women with juvenile idiopathic arthritis","volume":"71","author":"Smith","year":"2019","journal-title":"Arthritis Care Res"},{"key":"2026030508171940300_ref3","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1136\/ard-2022-222679","article-title":"Tumour necrosis factor inhibitor use during pregnancy is associated with increased birth weight of rheumatoid arthritis patients\u2019 offspring","volume":"81","author":"Smeele","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"2026030508171940300_ref4","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1002\/art.41191","article-title":"2020 American College of Rheumatology Guideline for the Management of Reproductive Health in rheumatic and musculoskeletal 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A retrospective cohort on the French National Health Insurance Database (EVASION)","volume":"113","author":"Luu","year":"2018","journal-title":"Am J Gastroenterol."},{"key":"2026030508171940300_ref17","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.3899\/jrheum.180588","article-title":"Pregnancy outcomes in couples with males exposed to longterm anti-tumor necrosis factor-\u03b1 inhibitor therapies: a prospective study","volume":"46","author":"Micu","year":"2019","journal-title":"J Rheumatol"},{"key":"2026030508171940300_ref18","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1038\/s41395-018-0202-9","article-title":"Pregnancy outcomes reported during the 13-year TREAT registry: a descriptive report","volume":"113","author":"Lichtenstein","year":"2018","journal-title":"Am J Gastroenterol"},{"key":"2026030508171940300_ref19","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1038\/ajg.2016.405","article-title":"Birth outcomes in children fathered by men treated with anti-TNF-\u03b1 agents before conception","volume":"111","author":"Larsen","year":"2016","journal-title":"Am J Gastroenterol"},{"key":"2026030508171940300_ref20","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1093\/rheumatology\/ket390","article-title":"No evidence for an increased risk of adverse pregnancy outcome after paternal low-dose methotrexate: an observational cohort study","volume":"53","author":"Weber-Schoendorfer","year":"2014","journal-title":"Rheumatology"},{"key":"2026030508171940300_ref21","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1097\/AOG.0000000000001936","article-title":"Risk of adverse pregnancy outcome after paternal exposure to methotrexate within 90 days before pregnancy","volume":"129","author":"Eck","year":"2017","journal-title":"Obstet Gynecol"}],"container-title":["Modern Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mr\/advance-article-pdf\/doi\/10.1093\/mr\/roaf087\/64549534\/roaf087.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/36\/2\/181\/64549534\/roaf087.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/36\/2\/181\/64549534\/roaf087.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T13:17:23Z","timestamp":1772716643000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mr\/article\/36\/2\/181\/8277631"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,8]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,10,8]]},"published-print":{"date-parts":[[2026,3,5]]}},"URL":"https:\/\/doi.org\/10.1093\/mr\/roaf087","relation":{},"ISSN":["1439-7595","1439-7609"],"issn-type":[{"value":"1439-7595","type":"print"},{"value":"1439-7609","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2025,10,8]]}}}