Risk Unknown

  • Abatacept (Orencia) – no adverse effects have been reported in animal studies; however, there are no studies of the drug’s safety in human pregnancy
  • Anakinra (Kineret) – no adverse effects have been reported in animal studies; however, there are no studies of the drug’s safety in human pregnancy
  • Celecoxib (Celebrex) – Large doses cause birth defects in rabbits; effects on people are not known.
  • TNF inhibitors – adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade) – There are no controlled studies in human pregnancy; however, numerous case reports and animal studies suggest they are safe.
  • Rituximab (Rituxan) – The drug may pass to the infant, causing depletion of B-cells. Long-term results are unknown.

Variable

  • Aspirin – safety is variable and depends on dose and time of use; low doses may protect against pregnancy loss in women with antiphospholipid antibodies, yet may cause bleeding in mother and baby if used too close to delivery; risks of high doses are unknown
  • Nonsteroidal anti-inflammatory drugs (NSAIDS) – naproxen (Naprosyn), ibuprofen (Motrin, Advil), ketoprofen (Orudis, Oruvail), nabumetone (Relafen), indomethacin (Indocin) – Safety is variable and depends on dose and time of use; use near delivery is not advised

During Breastfeeding

Dangerous/Off-limits

  • Methotrexate (Rheumatrex, Trexall) – drug is excreted in breast milk and can accumulate in the baby’s tissues
  • Leflunomide (Arava)
    Azathioprine (Imuran)

Probably safe

  • Hydroxychloroquine (Plaquenl) – probably safe; however, should be discontinued if baby developed jaundice
  • Infliximab (Remicade) – not shown to pass through breast milk
  • Prednisone (Deltasone) – Low doses are safe during breastfeeding; however, the drug may suppress breast milk production.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – probably safe during breastfeeding providing the newborn does not have jaundice
  • Sulfasalazine (Azulfidine)

Risk Unknown

  • Celecoxib (Celebrex)
  • Other TNF inhibitors
  • Abatacept (Orencia)
  • Anakinra (Kineret)