OPTIMUM USE OF DISEASE-MODIFYING AND IMMUNOSUPPRESSIVE ANTIRHEUMATIC AGENTS DURING PREGNANCY AND LACTATION

Women with rheumatic diseases frequently need treatment throughout pre gnancy and lactation. Physicians must confront the dual challenge of m onitoring the possible effects of the underlying maternal disease and the medications on both mother and child, It is essential that the mat ernal disease is well controlled before, during and after pregnancy to ensure the best possible outcome for the mother and child. Glucocorti coids have been used extensively in pregnant patients with systemic lu pus erythematosus and rheumatoid arthritis; there have been no reports of congenital malformations in the exposed infants. There is limited information on the safety of disease-modifying antirheumatic drugs, in cluding hydroxychloroquine, cyclosporin, oral and parenteral gold and sulfasalazine, during pregnancy, However, penicillamine, another disea se-modifying antirheumatic drug, is contraindicated during pregnancy. There is considerable experience with the use of azathioprine during p regnancy if the maternal condition requires a cytotoxic drug. There ha s been no increased risk of congenital malformations the exposed infan ts. The other cytotoxic drugs frequently used in the treatment of rheu matic diseases, chlorambucil, cyclophosphamide and methotrexate, are c ontraindicated during pregnancy. Glucocorticoids (such as prednisone a nd methylprednisolone) and hydroxychloroquine are considered to be saf e during lactation. Oral and parenteral gold and sulfasalazine can be used with caution during lactation. Penicillamine, cyclosporin and all cytotoxic drugs are contraindicated during lactation.