•Rheumatoid arthritis (RA) disease activity may improve during pregnancy but postpartum flares are common. • Patients taking disease-modifying antirheumatic drugs should be counselled about effective contraception. • Knowledge about drug safety in pregnancy is limited but the Therapeutic Goods Administration categories and online resources are a guide to the data currently available. • Begin prepregnancy counselling as early as possible to allow for cessation of teratogenic medications and optimisation of RA disease control. • For unplanned pregnancies, cease teratogenic medications immediately and refer to a genetic counsellor and maternal-fetal medicine specialist for risk assessment and advice.