Terapie revmatických chorob v graviditěa v laktaci

Treatment of inflammatory rheumatic disorders in pregnancy and lactation

Course of pregnancy and lactation in patients with rheumatic disorders and pharmacologicaltreatment of these disorders might be risky. The risk is a consequence of the disease, treatment ofthe mother before conception, during pregnancy and lactation. Treatment of the father just in theperiod of time shortly before conception can also be risky. The choice of the treatment of rheumaticdisorders in pregnancy and lactation is given mainly by the character of the disease, by its usualcourse during pregnancy, by the activity, eventually by the affection of internal organs and by theoccurrence of intercurrent disease of the woman, by the age of the women, and so on. That is thereason of the different approaches to the treatment of rheumatic disorders. Low levels of glucocorticoids,sulfasalazine andantimalarials are safe.Treatment with gold, azathioprine andcyclosporineA is not eligible during pregnancy, but in some exceptional cases can be assumed. Treatment withmethotrexate, penicillamine, leflunomide and cyclophosphamide is strictly contraindicated. It isnecessary to ensure effective contraception during the treatment and to discontinue these drugsbefore conception is planned. During the cyclophosphamide treatment it is also necessary to protectthe ovarian follicles before the conception to avoid irreversible amenorrhoea. For this purposehormonal contraception or cryopreservation of ovarian follicles can be used.

Key words:
rheumatic disorders, pregnancy, lactation, pharmacological treatment