Guidelines for prescribing rheumatology drugs in pregnancy

Thursday, 14 Jan 2016

The British Society of Rheumatology has published updated guidelines for health professionals on prescribing drugs in pregnancy and during breastfeeding.

Part one of the guidelines cover DMARDs and corticosteroids, and part two addresses analgesics and other drugs used in rheumatology practice.

Key findings in the guidelines include:

  • Prednisolone is compatible with each trimester of pregnancy and is the preferred corticosteroid in the treatment of maternal rheumatic disease in pregnancy.
  • Hydroxychloroquine remains the antimalarial of choice in women planning a pregnancy with rheumatic disease in need of treatment and should be continued during pregnancy.
  • Methotrexate at any dose should be avoided in pregnancy and stopped three months in advance of conception.
  • To ensure low/no levels of TNFα inhibitors (TNFi) in cord blood at delivery etanercept and adalimumab should be avoided in the third trimester and infliximab stopped at 16 weeks because of a theoretical increased infection risk in new-borns. If these drugs are continued later in pregnancy to treat active disease then live vaccines should be avoided in the infant until seven months of age.
  • Based on limited evidence certolizumab pegol is compatible with all three trimesters of pregnancy and has reduced placental transfer compared with other TNFi

Commenting on the guidelines, lead author Dr Ian Giles, PhD FRCP, Professor at the Centre for Rheumatology Research, UCL Division of Medicine said: “The BSR guidelines will enable medical practitioners to have a more confident and consistent approach to prescribing anti-rheumatic drugs in pregnancy and breastfeeding. I hope that this approach will allow adequate control of inflammatory rheumatic disease activity and prevent the unnecessary withdrawal of disease ameliorating anti-rheumatic therapies which have not been shown to be harmful in pregnancy and breastfeeding.“

Both sets of guidelines are published online in Rheumatology and can be accessed for free here. 

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