RESEARCH - Antirheumatic drugs in pregnancy and lactation

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Semin Arthritis Rheum. 2005 Oct;35(2):112-21. Links

Antirheumatic drugs in pregnancy and lactation.

Division of Rheumatology, Department of Internal Medicine, Saint Louis

University, MO 63104, USA.

OBJECTIVE: To review the toxicity issues of commonly used antirheumatic

drugs in pregnancy and lactation. METHODS: A review of the medical

literature using Medline database via Ovid was performed to identify the

toxicities of antirheumatic drugs in pregnancy and lactation. RESULTS: Many

rheumatologic diseases in women often first present during the childbearing

years. In most cases, antirheumatic therapy is required for their disease

control. Glucocorticoids may be used during pregnancy; however,

first-trimester use should be avoided if possible and breastfeeding should

occur 4 hours after the last dosing. Nonsteroidal antiinflammatory drugs

(NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors should be discontinued 6 to

8 weeks before delivery. NSAIDs are compatible with lactation, although

there is potential risk of jaundice and kernicterus. There is insufficient

data on COX-2 inhibitors and lactation. Hydroxychloroquine and sulfasalazine

may be continued throughout pregnancy and lactation. Methotrexate and

leflunomide are contraindicated during pregnancy and lactation.

Cyclophosphamide and mycophenolate mofetil should be avoided during

pregnancy and lactation. Azathioprine and cyclosporine A could be used with

caution during pregnancy if felt there is a need to suppress disease

activity. They are not compatible with breastfeeding. There are insufficient

data regarding tumor necrosis factor-antagonists, anakinra, and rituximab in

relation to pregnancy and lactation. Male patients should be made aware of

the effects methotrexate, leflunomide, sulfasalazine, and cyclophosphamide

may have on their fertility.

CONCLUSIONS: Health care providers should discuss the risks and benefits of

antirheumatic therapy during conception, pregnancy, and lactation with their

patients. Better maternal and fetal outcomes can be expected if the

pregnancy is planned, the rheumatic disease is stable, and if appropriate

medication adjustments can be made ahead of time.

PMID: 16194696

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus & db=pubmed & cmd=R\

etrieve & dopt=abstractplus & list_uids=16194696

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