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Connective tissue disorders and pregnancy. Recommendations for prescribing
1Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, USA. william-rayburn@uokhsc.edu
The Journal of Reproductive Medicine
|May 16, 1998
Summary
This review examines medications for women with connective tissue disorders during pregnancy and breastfeeding. While risks are generally unproven, potential fetal issues like immunosuppression and growth restriction warrant careful consideration.
Area of Science:
- Rheumatology
- Pharmacology
- Maternal-Fetal Medicine
Background:
- Connective tissue disorders (CTDs) affect women of childbearing potential.
- Management of CTDs during pregnancy requires careful drug consideration.
- Limited data exists on drug safety during gestation for CTDs.
Purpose of the Study:
- To review drug use in pregnant and breastfeeding women with CTDs.
- To discuss risks and outcomes associated with specific medications.
Main Methods:
- Literature review of drug use in pregnant/breastfeeding women with CTDs.
- Summary of known perinatal outcomes for various immunosuppressants and anti-inflammatory agents.
Main Results:
- Maintenance therapy principles remain consistent during pregnancy.
- Distinguishing drug risks from disease or pregnancy symptoms is challenging.
- While placental transfer occurs, risks of abortion, malformation, or stillbirth are often negligible or unproven.
- Potential long-term fetal effects include pancytopenia, immunosuppression, craniofacial abnormalities, and restricted growth.
- Drugs transfer in small amounts into breast milk.
Conclusions:
- Perinatal outcomes following in utero exposure to prednisone, NSAIDs, antimalarials, gold salts, methotrexate, cyclophosphamide, and azathioprine are described.
- Risk-benefit assessment is crucial for drug selection in pregnant/breastfeeding women with CTDs.