Presented by Megan Clowse, MD, a rheumatologist and associate professor of medicine at Duke University
Many women with autoimmune conditions wonder whether they should stop or continue their medications during pregnancy or breastfeeding. Patients often ask whether it is riskier to stop or continue medication while trying to conceive, during pregnancy, and while breastfeeding. What do women and their doctors need to consider when evaluating the safety, risks, and benefits of medications during these periods? How do you weigh the impact of both the disease and its treatment on your own health and your baby’s?
During this webinar, Duke University rheumatologist Megan Clowse, MD, discusses these important topics and her research, which focuses on the management of rheumatologic diseases in patients of childbearing age and utilizes the Duke Autoimmunity in Pregnancy Registry, which includes more than 500 pregnancies in women with rheumatic disease seen in the last decade.
Fast Facts from the Webinar
1. High disease activity during pregnancy can be more dangerous than certain medications
Active rheumatic disease and the subsequent inflammation are more dangerous to the pregnancy than certain medications. It is important to maintain low disease activity while pregnant and to avoid getting pregnant when in high disease activity through the use of effective contraception. The more organ involvement you have with your disease, the higher the risk of bad outcomes to your pregnancy. Hence it is important to monitor and treat rising disease activity during pregnancy.
2. Some medications are not safe during pregnancy, but there are many options that are
Three main rheumatologic medications are known to cause birth defects: methotrexate (Otrexup™, Rasuvo®, Rheumatrex® and Trexall™), mycophenolate (Myfortic® and CellCept®) and cyclophosphamide (Cytoxan®, Cytoxan Lyophilized®, Neosar®).
However, other medications may be used safely during pregnancy, such as hydroxychloroquine (Plaquenil®) and chloroquine, azathioprine (Imuran®, Azasan®), tacrolimus (Prograf®, Astagraf XL®), cyclosporine (Gengraf®, Neoral®, SandIMMUNE®), IVIg, corticosteroids (Prednisone, Medrol®, Deltasone®), and colchicine (Colcrys®, Mitigare®). In addition, there is a lot of good data on TNF-inhibitors (Humira®, Cimzia®, Enbrel®, Remicade®, Simponi®) showing safety in pregnancies for women with inflammatory bowel disease and arthritis.
3. Some women experience fewer flares during pregnancy
Rheumatoid arthritis (RA) and multiple sclerosis (MS) improve in about half of women during pregnancy and flare in about half after delivery. Often the same women get better and then get worse.
About the Presenter
Megan Clowse, MD, is a rheumatologist and associate professor of medicine at Duke University. Dr. Clowse leads the Reproductive Concerns Research Interest Group (RIG), which is part of a larger collaborative research group called the Autoimmune and Systemic Inflammatory Syndromes Collaborative Research Group (ASIS CRG).
This webinar was produced with the Autoimmune and Systemic Inflammatory Syndromes Collaborative Research Group (ASIS CRG). As part of the National Patient-Centered Clinical Research Network, this research group collaborates with stakeholders including patients, caregivers, advocacy groups, providers, and funders early on to move research forward more quickly and more efficiently. Learn more about our work here.
Get Involved in Arthritis Research
If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.