Pharmacotherapy of Rheumatic Diseases in Pregnancy

Females are more prone than males to rheumatologic diseases. Degenerative diseases more frequently occur after fertile years, but inflammatory or autoimmune disorders often manifest themselves during women's childbearing years. Disease which remains active during pregnancy may require drug treatment either for the benefit of the mother or in order to protect pregnancy and/or the fetus. Therapy with non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anticoagulants, immunosuppressive or even cytotoxic drugs may be crucial to acquire control of disease. But the use of antirheumatic drug during pregnancy may lead to increased risk of teratogenocity; possible long-term effects on the infant and maternal side effects which interfere with pregnancy. In the pregnant women with rheumatic disorders discontinuation of therapy with antirheumatic drugs may have advantages and many disadvantages and any treatment plan must be individually discussed. Cyclophosphamide, leflunomide and methotrexate use during pregnancy should be avoided and therapy should be discontinued at least 3 months before planned conception. Sulfasalazine therapy should be discontinued before planned pregnancy. NSAIDs and anti-malarial therapy can be continued until pregnancy is discovered. ASA and low doses of short acting NSAIDs can be taken during pregnancy and should be withdrawn 6 to 8 weeks before delivery and the treatment should be stopped by week 32 of pregnancy. Paracetamol, prednisolone and azathiopryne are the safest drugs to be used in pregnancy. Information concerning safety of biological treatment during pregnancy is insufficient (Adv Clin Exp Med 2008, 17, 4, 423-431).