The medical management of the rheumatology patient during pregnancy

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

Abstract

Decisions regarding medication use during pregnancy are amongst the most challenging clinicians will face. The health of both the mother and the developing fetus must be taken into account when designing a treatment plan. Limited data on an individual drug's risk for use during pregnancy and conflicting recommendations regarding drug safety contribute to uncertainty in therapy choices. Clinicians and patients individually have their own risk tolerance for prescribing and taking medications. Finally, pregnancy itself can impact an individual patient's disease activity rendering typical treatment approaches invalid. This chapter will discuss the treatment of the pregnant and nursing woman with a rheumatic disease. It will review the literature on commonly used medications for rheumatic disease management including aspirin, the nonsteroidal anti-inflammatory medications and COX-2 inhibitors; the glucocorticoids; the antimalarials; sulfasalazine; the immunosuppressive agents azathioprine and 6-mercaptopurine, cyclosporine, mycophenolate mofetil, and tacrolimus; the anti-metabolite methotrexate; leflunomide; cylophosphamide; intravenous immunoglobulin; the biologics including tumor necrosis factor-α (TNF-α) blockers, rituximab, belimumab, actemra, anakinra, abatacept, and tocilizumab; the anti-coagulants warfarin and unfractionated and fractionated heparin and colchicine. Wherever possible, specific recommendations will be made.

Original languageEnglish (US)
Title of host publicationContraception and Pregnancy in Patients with Rheumatic Disease
PublisherSpringer New York
Pages273-287
Number of pages15
ISBN (Electronic)9781493906734
ISBN (Print)1493906720, 9781493906727
DOIs
StatePublished - Mar 1 2014

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ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bermas, B. L. (2014). The medical management of the rheumatology patient during pregnancy. In Contraception and Pregnancy in Patients with Rheumatic Disease (pp. 273-287). Springer New York. https://doi.org/10.1007/978-1-4939-0673-4_14