How safe are anti-rheumatic drugs during pregnancy?

- The risk for congenital malformations from low-dose weekly methotrexate is low.
- Mycophenolate mofetil increases both miscarriage and birth defects significantly.
- Leflunomide does not appear to be a human teratogen when a washout is performed.
- Azathioprine is not gonadotoxic in men.
- Certolizumab does not increase adverse pregnancy outcomes.

Rheumatic diseases may be active during pregnancy necessitating drug treatment in order to control maternal disease activity and ensure a successful pregnancy outcome. The present literature survey of the last 2 years does not profoundly change the recommendations given in recent reviews: the teratogenic drugs cyclophosphamide, methotrexate, mycophenolate mofetil, and biologics without or with few pregnancy data must be withdrawn before a planned pregnancy. Leflunomide has up to date not shown to be a human teratogen. Drugs that can be used throughout pregnancy include corticosteroids, sulfasalazine, antimalarials, cyclosporine, tacrolimus and azathioprine. Among biological drugs extended pregnancy experience exists only for TNF-inhibitors. The effect of immunosuppressive drugs and biologics on male reproductive function is only partly known.

106