In pregnancy, more than any other time, you and your doctor must weigh the benefits and risks of the medications you are taking.  Some medications may be required to keep your disease under control – or even save the life of your unborn child – while others may actually cause pregnancy loss or irreparable damage to your baby.

Similarly, some are safe during pregnancy, while others can be passed through your milk, potentially harming your baby.

Following is a breakdown of the drugs most commonly used for arthritis. While some are contraindicated during pregnancy and/or breastfeeding, others may be used – or even advised. In all cases, it’s necessary to work with a rheumatologist and high-risk obstetrician to determine what’s best for you and your baby.

Dangerous/Off-limits

• Chlorambucil (Leukeran) – may cause miscarriage or birth defects
• Cyclophosphamide (Cytoxan) – may cause miscarriage or birth defects
• Leflunomide (Arava) – may cause miscarriage or birth defects
• Methotrexate (Rheumatrex) – may cause miscarriage or birth defects
• Warfarin (Coumadin) – may cause birth defects or severe hemorrhage

Probably Safe

• Azathioprine (Imuran) – not associated with increased risk of fetal abnormalities
• Cyclosporine (Neoral, Sandimmune)
• Corticosteroids (in general) – are considered relatively safe in low doses; however, they may increase the risk of some problems in the mother including hypertension and gestational diabetes and may cause babies to be small for their gestational age.
•  Specific corticosteroids:
  • Betamethasone (Celestone) – crosses placenta, used in late pregnancy to aid lung development in fetuses at risk of premature birth
  • Dexamethasone (Decadron, Hexadrol) – also used in late pregnancy to aid fetal lung development; used in mid- and late pregnancy to treat fetal heart block
• Heparin (Calciparine, Liquaemin) – may be used to prevent placental blood clots in women with antiphospholipid antibodies
• Hydroxychloroquine sulfate (Plaquenil) – probably safe, according to a series of small studies
• Intravenous immunoglobulin
• Low molecular weight heparin – may be used to prevent placental blood clots
• Sulfasalazine – not shown to adversely affect fetus

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)