Immunosuppressive drug use during pregnancy

Area of Science:

• Rheumatology
• Obstetrics
• Pharmacology

Background:

• Rheumatic diseases often require treatment during pregnancy and lactation.
• Managing maternal disease and medications poses risks to both mother and child.
• Optimal maternal disease control is crucial for favorable pregnancy outcomes.

Purpose of the Study:

• To review the safety of medications used for rheumatic diseases during pregnancy and lactation.
• To provide guidance on medication choices for pregnant and lactating women with rheumatic conditions.

Main Methods:

• Literature review of studies on medication use in pregnant and lactating women with rheumatic diseases.
• Analysis of safety data regarding congenital malformations and infant outcomes.
• Assessment of drug contraindications during pregnancy and lactation.

Main Results:

• Corticosteroids (prednisone, methylprednisolone) and azathioprine have established safety profiles in pregnancy with no increased risk of malformations.
• Limited safety information exists for 6-mercaptopurine, cyclophosphamide, and cyclosporine.
• Methotrexate is contraindicated in pregnancy; chlorambucil use is discouraged due to safer alternatives.
• Corticosteroids are safe during lactation; other immunosuppressants are contraindicated.

Conclusions:

• Careful selection of medications is essential for managing rheumatic diseases in pregnant and lactating women.
• Corticosteroids and azathioprine are preferred options when immunosuppression is necessary.
• Physicians must weigh risks and benefits, prioritizing maternal and fetal well-being.