Abstract :
Rheumatic disease inspite of improvement during pregnancy, is a challenging problem. The disease has a tendency to flare up in immediate postpartum stage and sometimes also during pregnancy. Hence, planning of pregnancy should be deferred to the stage when the rheumatic diseases are quiescent for six to twelve months. Drugs with teratogenic effects like methotrexate and leflunomide must be stopped three to six months prior to conception.
Lower dosage of corticosteroid is advocated with a limit upto 10 mg /day. In third trimester NSAIDs must be avoided. The safer drugs during pregnancy are sulfasalazine, hydroxychloroquine and azathioprine. Cholestyramine wash or use of charcoal for leflunomide is must if this drug has been taken within two years of planned conception.
With lack of evidence regarding teratogenic potentials of biologics, they are to be withheld prior to conception, with the exception of TNF inhibitors, may be allowed to continue.
During lactation, NSAIDs preferably short acting Ibuprofen should be given just after feeding. In lactation, the drugs considered safe are the same as used during pregnancy - low dose corticosteroids, sulfasalazine, hydroxychloroquine, and azathioprine. Similarly, anti TNF agents are also considered safe during lactation. Evidence-based recommendations regarding use of DMARDs and biologics is a powerful tool / guide for rheumatologists in pregnant and lactating women with rheumatic diseases. Counselling of male patients with rheumatic diseases regarding conception is also mandatory.
Keyword :
DMARDs, TNF inhibitors, Lactation, Pregnancy, Rheumatic diseases.