Drugs in pregnancy. Rheumatological disorders

Rheumatic diseases occur frequently in women of childbearing years, necessitating drug treatment during a concurrent pregnancy in order to control maternal disease activity and to ensure a successful pregnancy outcome. Inflammatory rheumatic diseases with mainly musculoskeletal involvement may cause acute episodes of arthritis. Autoimmune, systemic diseases may flare with manifestations of haematological, dermatological or renal disease or give rise to thromboembolism during pregnancy. Treatment with non-steroidal anti-inflammatory drugs, corticosteroids, anticoagulants, immunosuppressive or even cytotoxic drugs may be required to acquire disease control. Unfortunately, controlled studies on the use of antirheumatic drugs during gestation exist only for a few drugs. This chapter presents data on the use of antirheumatic drugs during pregnancy, addressing the risk of teratogenicity, possible long-term effects on the infant exposed to drugs antenatally, and maternal side-effects which interfere with pregnancy. Recommendations for pre-pregnancy counselling and necessary adjustment of drug treatment before and during pregnancy are given.