2016 BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding—Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids
This is a handy reference on what rheumatic drugs are permissible in pre-conception, pregnancy and breastfeeding.
2016 BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding—Part II: analgesics and other drugs used in rheumatology practice
Part 2 of medicines use in pregnancy and lactation, focusing on painkillers.
As in women with chronic inflammatory conditions like Lupus, Rheumatoid Arthritis and Inflammatory Bowel Diseases, those with Ankylosing Spondylitis are at 2-3 times higher risk than the healthy population of having smaller-sized babies born preterm, and needing Cesarean delivery. Pre-eclampsia (kidney-threatening hypertension in pregnancy) is often the cause of emergency Cesarean surgery.
That a greater proportion of patients with adverse pregnancy outcome were on anti-infl...ammatory medications may suggest more severe disease activity rather than the drugs prejudicing the outcome.
Practically all pregnant patients would rather go through pregnancy (and lactation even) without taking any medication, preferring to suffer the ravages of their rheumatic diseases than to expose their unborn babies to any risk of drug toxicity. However, the active disease is far more likely to be detrimental to the health of both mother and child. The logical way forward is to preferably enter pregnancy with disease under good control, monitor both disease and foetus closely during gestation, and if necessary to treat disease flares with the appropriate and safe medications listed in the guidelines posted earlier (in consultation with the obstetrician and rheumatologist, of course).
Just when you thought the last authoritative word was said about the safety of anti-TNFs in pregnancy, along comes a bummer.
While causality cannot be surmised, mainly from a lack of plausible mechanism (large biologic molecules not likely to cross the placenta in the first trimester when teratogenicity is most likely), higher disease activity in Etanercept users was not evident in this study to explain away the doubling of major malformation risk.