Treating rheumatic diseases in pregnancy: dos and don'ts

Area of Science:

• Pharmacology
• Obstetrics
• Maternal-Fetal Medicine

Background:

• Current evidence and recommendations for drug use in pregnancy often conflict with clinical experience.
• Published studies may not adequately account for physiological changes during gestation.
• Differences between animal models and human pregnancies complicate extrapolation of safety data.

Purpose of the Study:

• To critically appraise existing evidence and recommendations on pharmaceuticals and biologicals in pregnancy.
• To identify factors contributing to the variance between clinical practice and published guidelines.
• To emphasize the importance of considering gestational stage and long-term effects in pregnancy interventions.

Main Methods:

• Critical review of current scientific literature and clinical guidelines.
• Analysis of physiological changes during pregnancy and their impact on drug pharmacokinetics and pharmacodynamics.
• Comparison of data from animal studies and human pregnancies.

Main Results:

• Significant discrepancies exist between clinical observations and published recommendations for drug use in pregnancy.
• Physiological alterations during pregnancy, varying by gestational stage, influence drug efficacy and safety.
• Potential for delayed adverse effects of medications used during pregnancy, manifesting in adulthood.

Conclusions:

• Physicians must consider the dynamic physiological changes of pregnancy when prescribing.
• The stage of gestation is a critical factor determining the safety and efficacy of pharmaceutical interventions.
• Long-term monitoring is essential, as some drug effects may not be apparent until later in life.