Purpose of reviewDisease activity of rheumatoid arthritis (RA) can ameliorate spontaneously during pregnancy; however, adequate measurement of disease activity during pregnancy is a challenge, as is quantifying disease improvement during pregnancy and disease flare postpartum. Adverse pregnancy outcomes may be related to high disease activity during pregnancy, the full extent of which remains to be fully defined.Recent findingsDisease activity might best be measured during pregnancy with DAS28-CRP without visual analogue scale (VAS) general health. Pregnancy outcome seems to be worse in patients with RA compared with healthy controls. High disease activity of RA may contribute importantly both to the longer time to conceive and worse pregnancy outcome.SummaryLow disease activity of RA before, during and after pregnancy may be best for both mother and child. Counselling of patients on reproductive health and preconception treat-to-target management may help to achieve lower disease activity. This may result in better pregnancy outcomes.