This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Østensen, M Search for Related Content PubMed PubMed Citation Articles by Østensen, M Social Bookmarking                         What's this?

Disease specific problems related to drug therapy in pregnancy

Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Berne, Switzerland, monika.oestensen{at}insel.ch

Rheumatic diseases occur frequently in women of childbearing years necessitating drug treatment also during a concurrent pregnancy in order to control maternal disease activity and to ensure a successful pregnancy outcome. 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 rheumatic disease flares and for prevention of serious organ manifestations. 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 decides if 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. Prepregnancy counselling and careful monitoring during pregnancy help to tailor necessary drug treatment for the benefit of mother and child.

Key Words: corticosteroids • immunosuppressive drugs • methotrexate • nonsteroidal anti-inflammatory drugs • pregnancy • TNF alpha inhibitors

Lupus, Vol. 13, No. 9, 746-750 (2004)
DOI: 10.1191/0961203303lu2004oa


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. G. Affleck and V. K. Walker Transgenic Rescue of Methotrexate-Induced Teratogenicity in Drosophila melanogaster Toxicol. Sci., October 1, 2007; 99(2): 522 - 531. [Abstract] [Full Text] [PDF]

				J. P. Dhar and R. J. Sokol Lupus and Pregnancy: Complex Yet Manageable Clin. Med. Res., December 1, 2006; 4(4): 310 - 321. [Abstract] [Full Text] [PDF]

				P. Saar, W. Hermann, and U. Muller-Ladner Connective tissue diseases and pregnancy Rheumatology, October 1, 2006; 45(suppl_3): iii30 - iii32. [Abstract] [Full Text] [PDF]

				D. B. McKay and M. A. Josephson Pregnancy in recipients of solid organs--effects on mother and child. N. Engl. J. Med., March 23, 2006; 354(12): 1281 - 1293. [Full Text] [PDF]

				S Germain and C Nelson-Piercy Lupus nephritis and renal disease in pregnancy Lupus, March 1, 2006; 15(3): 148 - 155. [Abstract] [PDF]

				M De Santis, G Straface, A Cavaliere, B Carducci, and A Caruso Paternal and maternal exposure to leflunomide: pregnancy and neonatal outcome Ann Rheum Dis, July 1, 2005; 64(7): 1096 - 1097. [Full Text] [PDF]