Rheumatic Disease & Reproductive Health

Medication Guides & More

With regard to medication recommendations, the guides developed by Dr. Clowse and colleagues include information on which treatments are safe, or not safe, in pregnancy. Azathioprine tends to be a go-to medication that is compatible with pregnancy, and all patients with SLE should be on hydroxychloroquine, which is known to reduce lupus disease activity and adverse outcomes in pregnancy.^4-7

If a change in medication is made, it may sometimes be reasonable for a patient to wait three to nine months after this change before conceiving to ensure the new medication regimen remains effective.

Dr. Clowse encourages providers to have a plan for other issues that may arise. Examples include appropriate anticoagulation for patients with antiphospholipid syndrome, monitoring for congenital heart block in patients with anti-SSA antibodies, avoidance of ACEi/ARB medications during pregnancy and plans for how to manage pain during pregnancy.

Jason Liebowitz, MD, is an assistant professor of medicine in the Division of Rheumatology at Columbia University Vagelos College of Physicians and Surgeons, New York.

 References

1. Venne K, Scott S, Bernatsky S, Vinet E. Induced abortions in women with systemic lupus erythematosus. Lupus. 2021;30(3):484–488.
2. Dobbs, State Health Officer of the Mississippi Department of Health, et al. v. Jackson Women’s Health Organization et al. U.S. Supreme Court. 2022 Jun 24.
3. Bermas BL, Blanco I, Blazer AD, et al. Overturning Roe v. Wade: Toppling the practice of rheumatology. Arthritis Rheumatol. 2022 Dec;74(12):1865–1867.
4. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Care Res (Hoboken). 2020;72(4):461–488.
5. Sperber K, Hom C, Chao CP, et al. Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases. Pediatr Rheumatol Online J. 2009 May 13;7:9.
6. Clowse MEB, Magder L, Witter F, et al. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum. 2006 Nov;54(11):3640–3647.
7. Costedoat-Chalumeau N, Amoura Z, Duhaut P, et al. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: A study of one hundred thirty-three cases compared with a control group. Arthritis Rheum. 2003 Nov;48(11):3207–3211.