A Hurrell on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group (2016). They should be essential in everyday clinical decision making. There are no data relating to paternal exposure to anakinra, but it is unlikely to be harmful (LOE 4, GOR D, SOA 98.9%). d Suggested monitoring of maternal blood pressure, renal function, blood glucose and drug levels. Tramadol is compatible with pregnancy, although there have been no high-quality studies published investigating the safety of tramadol in pregnancy (LOE 2−, GOR D, SOA 98.4%). Based on very limited evidence, MMF is compatible with paternal exposure (LOE 2−, GOR D, SOA 98.9%). Prednisolone is compatible with breastfeeding (LOE 2−, GOR D, SOA 98.9%). Flint 2016, 55(9). Lockshin f Unintentional first trimester exposure is unlikely to be harmful. There are no data on which to base a recommendation regarding paternal exposure to gabapentin or pregabalin (SOA 100%). MTX at any dose should be avoided in pregnancy and stopped 3 months in advance of conception (LOE 2−, GOR D, SOA 100%). The Belgian Society of Radiology (BSR) aims to be the premier Belgian radiological society that represents its members at the national, international, federal and community level.It wants to be the unifying channel through which communication and advocacy is organised with the authorities, organisations and bodies that … Based on limited data, women should not be discouraged from breastfeeding on selective serotonin reuptake inhibitors (LOE 4, GOR D, SOA 98.4%). Limited evidence supports the use of sildenafil to treat PHT during pregnancy (LOE 3, GOR D, SOA 99.5%). AZA is compatible with paternal exposure (LOE 2+, GOR D, SOA 100%). Is it compatible with breastfeeding? Dose increases should be monitored by FBC, creatinine/calculated GFR, ALT and/or AST and albumin every 2 weeks until on stable dose for 6 weeks then revert to previous schedule (GRADE 2B, 97%). • The 2012 BSR and BHPR guideline for the treatment of psoriatic arthritis with biologics20 • The 2016 BSR and BHPR guideline in prescribing drugs in pregnancy and breastfeeding21. M Where possible, recommendations are made regarding compatibility with paternal exposure. No data exist on excretion into breast milk, therefore breastfeeding is not recommended (LOE 4, GOR D, SOA 99.5%). Guideline on prescribing drugs in pregnancy and breastfeeding Part 1: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective … The prescribing of many drugs in pregnancy is complicated by a lack of knowledge regarding their compatibility, leading to patient misinformation and withdrawal/denial of disease-ameliorating therapies. Summary of drug compatibility in pregnancy and breastfeeding. Sex differences in the associations between maternal prenatal distress and infant cortisol reactivity and recovery. f No studies identified, but unlikely to be harmful. [A survey among breeders of South American camelids concerning breeding and reproduction management]. Please check for further notifications by email. In women treated with low-dose MTX within 3 months prior to conception, folate supplementation (5 mg/day) should be continued prior to and throughout pregnancy (LOE 1, GOR B, SOA 98.4%). Østensen Rivaroxaban and dabigatran cannot be recommended in pregnancy or breastfeeding due to a lack of human data and concerns from animal studies (LOE 4, GOR D, SOA 100%). Fortunately, the British Society for Rheumatology (BSR) guidelines and European League Against Rheumatism (EULAR) recommendations concerning prescribing anti-rheumatic drugs in pregnancy were published in 2016. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: Analgesics and other drugs used in rheumatology practice. There are insufficient data on which to base a recommendation regarding paternal exposure to ACEIs, but there are no theoretical concerns (LOE 4, GOR D, SOA 100%). There is limited evidence on which to base a recommendation for anakinra in pregnancy, but unintentional exposure in the first trimester is unlikely to be harmful (LOE 2−, GOR D, SOA 96.8%). Based on limited evidence, LEF may not be a human teratogen but it is still not recommended in women planning pregnancy (LOE 2+, GOR C, SOA 100%). More frequent monitoring is appropriate in patients at higher risk of toxicity (GRADE 2B, 97%). M.G. Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review No data exist on excretion into breast milk, therefore breastfeeding is not recommended (LOE 4, GOR D, SOA 100%). For Permissions, please email: journals.permissions@oup.com. Published by Oxford University Press on behalf of the British Society for Rheumatology. M.N. Khamashta Disclosure statement : K.S. HCQ remains the antimalarial of choice in women planning a pregnancy with rheumatic disease in need of treatment and should be continued during pregnancy (LOE 1 ++, GOR A, SOA 100%). Based on very limited evidence, LEF may be compatible with paternal exposure (LOE 4, GOR D, SOA 98.9%). S There are no data on ABA use in breastfeeding (SOA 100%). Cushing's Syndrome in a Pregnant Patient Secondary to Adrenal Adenoma: Treatment With Unilateral Adrenalectomy. Patients looking for further information on whether their condition places them in a higher-risk category, or about precautions they should take, are advised to speak to their clinical team, who are best placed to answer … For recommendations on prescribing anti-rheumatic drugs in pregnancy and breastfeeding, see the BSR and BHPR guideline part I [ 4 ]. Treatment paradigms for managing pregnancy in rheumatoid arthritis (RA) have been challenged in recent years with the introduction of new agents and reclassification of drug safety during pregnancy by the FDA. Mothers on CSA should not be discouraged from breastfeeding (LOE 3, GOR D, SOA 100%). Codeine is compatible peri-conception and throughout pregnancy. Avoid regular use during weeks 8–14 of pregnancy due to a small reported risk of cryptorchidism (LOE 2+, GOR C, SOA 99.5%). 2016-01-18T00:00:00. L.M. Fluoxetine, paroxetine and sertraline are compatible with pregnancy (LOE 2 ++, GOR C, SOA 97.9%). For further information and caveats, see relevant recommendations and main text in executive summary and full guideline. has received individual support to attend meetings from GlaxoSmithKline, UCB and Astra-Zeneca, chairing fees from Bristol-Myers Squibb and honoraria from GlaxoSmithKline/Human Genome Sciences, MedImmune, INOVA Diagnostics and Merck. Methylprednisolone has rates of placental transfer similar to prednisolone with equivalent anti-inflammatory effects at 80% of prednisolone dose and would therefore be expected to be compatible with pregnancy, breastfeeding and paternal exposure (LOE 4, GOR D, SOA 93.7%). HCQ is compatible with breastfeeding (LOE 4, GOR D, SOA 98.9%). Specific questions were considered in relation to each drug. Funding : No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. Funding : No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. The guideline working group considered the evidence supporting the use of corticosteroids, disease modifying drugs, biologics and other drugs alongside their own experience. The use of biologic therapies has transformed the management of inflammatory arthritis (IA). MTX cannot be recommended in breastfeeding because of theoretical risks and insufficient outcome data (LOE 4, GOR D, SOA 100%). c Conception may be enhanced by stopping SSZ for 3 months prior to conception. M.K. Treatment with MMF should be stopped at least 6 weeks before a planned pregnancy (LOE 3, GOR D, SOR 100%). M Intermittent use is advised because of a small risk of wheeze and childhood asthma with prolonged paracetamol use in pregnancy (LOE 2+, GOR C, SOA 99.5%). et al. ACEIs should be stopped as soon as possible when pregnancy is confirmed in the first trimester and, if necessary, an alternative antihypertensive compatible with pregnancy should be given (LOE 2 ++, GOR B, SOA 100%). Copyright © 2020 British Society for Rheumatology. These guidelines are for healthcare professionals directly involved in managing patients with rheumatic disease in the UK who are (or planning to become) pregnant and/or breastfeeding, men planning to conceive and patients who have accidentally conceived while taking these medications. Given their biological half-life in bone of up to 10 years and no evidence of harm from limited reports of their use in pregnancy, a pragmatic recommendation is that they should be stopped 3 months before pregnancy (LOE 4, GOR D, SOA 98.4%). has undertaken consultancies and received honoraria from Bristol-Myers Squibb, GlaxoSmithKline, MedImmune, Merck Serono and UCB, has been a member of speakers’ bureau for GlaxoSmithKline, UCB and Lilly and has received research grant support from UCB, but none of these activities have been related to the use of any specific drug in pregnancy. The human breast may selectively restrict the passage of captopril and/or enalapril from blood into breast milk, so it is unlikely to cause adverse effects in breastfed infants (LOE 3, GOR D, SOA 98.9%). There are no data relating to paternal exposure to codeine, but due to maternal compatibility, it is unlikely to be harmful (LOE 4, GOR D, SOA 98.9%). There are no data relating to paternal exposure to calcium channel blockers, but they are unlikely to cause harm (LOE4, GOR D, SOA 98.9%). BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice. There are no data relating to paternal exposure to tramadol, but due to maternal compatibility, it is unlikely to be harmful (LOE 4, GOR D, SOA 98.9%). b No studies identified, but unlikely to be harmful due to maternal compatibility. Lockshin Hurrell has received individual support to attend a meeting from Roche. Golimumab is unlikely to be harmful in the first trimester (LOE 4, GOR D, SOA 97.9%). Julia Flint, Sonia Panchal, Alice Hurrell, Maud van de Venne, Mary Gayed, Karen Schreiber, Subha Arthanari, Joel Cunningham, Lucy Flanders, Louise Moore, Amy Crossley, Neetha Purushotham, Amisha Desai, Madeleine Piper, Mohamed Nisar, Munther Khamashta, David Williams, Caroline Gordon, Ian Giles, on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group, BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding—Part II: analgesics and other drugs used in rheumatology practice, Rheumatology, Volume 55, Issue 9, September 2016, Pages 1698–1702, https://doi.org/10.1093/rheumatology/kev405. Disclosure statement : K.S. Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids, © The Author 2016. has received unit and individual support to attend meetings from UCB and Jansen UK and participated on an expert panel for UCB. Is it compatible with pregnancy? All rights reserved. Recommendations for corticosteroids in pregnancy and breastfeeding. Andreoli Author information: (1)Division of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, New York 10021, USA. There is no consensus on best practices for drug management during pregnancy by rheumatologists. There are insufficient data to recommend amlodipine in pregnancy, but there is no evidence of harm during pregnancy and an absence of evidence during breastfeeding (LOE 3, GOR D, SOA 99.5%). M . Updated 16 December You can find our COVID-19 guidance below. There are no data on which to base a recommendation for paternal exposure to bisphosphonates (SOA 100%). [Ambulatory and Home Blood Pressure Measurement in Hypertensive Pregnant Women]. Implementing guidelines Pregnancy and rheumatic diseases: best practice and prescribing considerations. 2016 NICE-accredited. 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