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Table 3 Drugs used in the treatment of autoimmune diseases/compatibility with pregnancy (adapted from Andreoli et al. [9])

From: Autoimmune diseases and pregnancy: analysis of a series of cases

Drug

FDA category

Permitted during pregnancy

Notes

Prednisolone

B

Allowed

Associated to medical/obstetric complications (maternal diabetes, preeclampsia, premature rupture of membranes)

NSAID

B/D

Allowed; avoid from 3rd trimester onward

Risk of premature closure of the arterial duct in the 3rd trimester

Hydroxychloroquine

C

Allowed

Discontinuation during pregnancy is associated with SLE exacerbations

Azathioprine

D

Allowed

In the smallest therapeutic dosage, if benefits outweigh risks

Cyclosporine

C

Allowed

 

Tacrolimus

C

Allowed

 

Sulfasalazine

B

Allowed

 

Methotrexate

X

Discontinue 3–6 months before a planned pregnancy

 

Cyclophosphamide

D

Discontinue at least 3 months before a planned pregnancy

 

Mycophenolatemofetil

D

Discontinue at least 6 weeks before a planned pregnancy

 

Warfarin

D

Discontinue after positive pregnancy test

Can be used while breastfeeding

LMWH

B

Allowed

Used as primary prevention of thrombotic events during the puerperal period

IVIG

C

Allowed

 

Rituximab

C

Discontinue at least 6–12 months before a planned pregnancy

 

Belimumab

C

Discontinue at least 4 months before a planned pregnancy

 
  1. FDA-assigned pregnancy categories (The United States Food and Drug Administration): A controlled studies in humans have failed to demonstrate a risk to the foetus, B no evidence of risk for the human species, C Teratogenic—risk to humans cannot be excluded, D clear evidence of risk to the human foetus—risk is acceptable in a situation of very high risk for the pregnant woman, in lack of safer alternatives, X Drugs considered unsafe during pregnancy.
  2. NSAID nonsteroidal anti-inflammatory drugs, LMWH low-molecular-weight heparin, IVIG intravenous immunoglobulin, SLE systemic lupus erythematosus.