How safe are anti-rheumatic drugs during pregnancy?

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Graphical abstractHighlightsThe risk for congenital malformations from low-dose weekly methotrexate is low.Mycophenolate mofetil increases both miscarriage and birth defects significantly.Leflunomide does not appear to be a human teratogen when a washout is performed.Azathioprine is not gonadotoxic in men.Certolizumab does not increase adverse pregnancy outcomes.Rheumatic diseases may be active during pregnancy necessitating drug treatment in order to control maternal disease activity and ensure a successful pregnancy outcome. The present literature survey of the last 2 years does not profoundly change the recommendations given in recent reviews: the teratogenic drugs cyclophosphamide, methotrexate, mycophenolate mofetil, and biologics without or with few pregnancy data must be withdrawn before a planned pregnancy. Leflunomide has up to date not shown to be a human teratogen. Drugs that can be used throughout pregnancy include corticosteroids, sulfasalazine, antimalarials, cyclosporine, tacrolimus and azathioprine. Among biological drugs extended pregnancy experience exists only for TNF-inhibitors. The effect of immunosuppressive drugs and biologics on male reproductive function is only partly known.

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