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Safety of antiinflammatory and immunosuppressive drugs in rheumatic diseases during pregnancy and lactation

Author
Bonnie L Bermas, MD
Section Editors
Daniel E Furst, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
Paul L Romain, MD

INTRODUCTION

Inflammatory disorders such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and inflammatory bowel disease (IBD) often occur in women of childbearing age; thus, the treatment of such disorders in women during pregnancy is an important aspect of their management.

When considering treatment options, a major tenet of treating women during pregnancy is to keep disease under good control while minimizing or avoiding medications that may increase maternal or fetal risk. The relative benefits and risks to the mother and fetus of using a particular medication to maintain disease control or to treat active disease during pregnancy depend upon the specific clinical context and may be influenced by gestational age and other factors. Importantly, untreated disease carries its own risks to both the mother and the developing fetus.

The risks of antiinflammatory and immunosuppressive medications in pregnancy and during lactation that are used for the treatment of rheumatic diseases will be reviewed here. Additional information regarding each medication is provided in the drug information topic for each agent. Approaches to the therapy of individual conditions are presented separately within the appropriate topic reviews on the treatment of given disorders, and for some conditions, in separate topic reviews. (See "Rheumatoid arthritis and pregnancy" and "Pregnancy in women with systemic lupus erythematosus".)

Strategies for the preservation of fertility in patients undergoing cytotoxic therapy; cryopreservation of sperm, oocytes, and embryos; and the effects of antiinflammatory and immunosuppressive medications on male fertility are discussed in detail separately. (See "Fertility preservation in patients undergoing gonadotoxic treatment or gonadal resection" and "Effects of antiinflammatory and immunosuppressive drugs on gonadal function and teratogenicity in men with rheumatic diseases".)

RISK CATEGORIES AND TREATMENT CONTEXT

The US Food and Drug Administration (FDA) has changed the format for labeling medications for use during pregnancy and lactation. The previous letter categories inaccurately implied increased risk as one went from category A to B to C to D to X; in actuality, these categories were designed to reflect the amount and type of data available. The system that began going into effect in mid-2015 provides a discussion of the available data regarding a particular drug's safety in pregnancy and lactation, as well as information regarding the risk of untreated disease [1].

                              
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Literature review current through: Nov 2017. | This topic last updated: Nov 13, 2017.
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