The use of antirheumatic medication during pregnancy and in the puerperium

Patients with rheumatic diseases will want to take as few medications as possible while they are conceiving, pregnant, or breast feeding. The guidelines above can be used to balance the risk of a drug effect on the fetus or neonate with the effect of provoking a flare in disease activity by ceasing the drug. Where no information on drug concentration in pregnancy or lactation exists, guidelines can be developed from knowledge of the drug's inherent metabolism. In most of the rheumatic diseases, disease activity can be reduced to a minimum using the smallest possible dose of drugs with known behaviors in pregnancy and lactation and thus providing minimal risk to mother and fetus.