Rheumatic diseases occur frequently in women of childbearing years making it necessary to undergo drug treatment concurrently with the pregnancy in order to control maternal disease activity and to ensure that the pregnancy itself is successful.
This survey reviews maternal and fetal side effects of nonsteroidal anti-inflammatory drugs (NSAID) and immunosuppressive agents in pregnant patients. The classic nonselective nonsteroidal anti-inflammatory drugs are not teratogenic, but given in late pregnancy they can induce renal and cardiac side effects in the fetus. Similar effects must be expected of the new, selective Cox2-inhibitors. NSAID should therefore be stopped by gestational week 32. Corticosteroids are frequently necessary to control flare ups of rheumatic disease and for prevention of serious organ defects. However, due to an increased risk of oral clefts, high doses (1-2 mg/kg) should be avoided in the first trimester. Among disease modifying drugs, sulfasalazine and antimalarials have the safest record. Cyclosporine and azathioprine can be given throughout pregnancy if disease control requires it. Insufficient data exist for treatment of pregnant patients with TNF-inhibitors and mycophenolate mofetil. The severity of the disease under treatment will dictate whether or not continuation of one of these drugs is justified. Prophylactic withdrawal of drugs before pregnancy is mandatory for leflunomide and the cytotoxic agents methotrexate and cyclophosphamide. Pre-pregnancy counselling and careful, stringent monitoring throughout the duration of the pregnancy aid in making the treatment beneficial for both the unborn child and the mother.(Source: Ostensen M., Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Berne, Switzerland)