The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation

Many rheumatic diseases affect women of childbearing age, and the medicatio ns used to treat these diseases may affect conception, pregnancy, fetal dev elopment, and lactation. Physicians who care for these women need to be awa re of the potential adverse effects of these medications, and which medicat ions can be used safely prior to conception and during pregnancy and lactat ion. Although reviews of individual classes of medications are available, t here is no practical and comprehensive review that summarizes all of this i nformation, and includes anticoagulant drugs and 2 recently approved drugs for rheumatoid arthritis. Women who take cytotoxic drugs should be informed of the risks of impaired fertility and congenital malformations, and must use effective methods of contraception. During pregnancy, nonsteroidal anti -inflammatory agents may be used until the: last 6 weeks, and low to modera te doses of corticosteroids are safe throughout pregnancy. Among the diseas e-modifying agents, sulfasalazine and hydroxychloroquine treatment may be m aintained. Cytotoxic drugs may be used after the first trimester to treat l ife-threatening disease. During lactation, prednisone, sulfasalazine, and h ydroxychloroquine may be used cautiously. Women using heparin for treatment of antiphospholipid antibody syndrome should lake measures to prevent: bon e loss. Men taking methotrexate, sulfasalazine, cyclosporine, azathioprine, or leflunomide should be apprised of the possibilities of infertility and teratogenicity.