Pharmacotherapy of rheumatic diseases in pregnancy

Česká verze

Authors: Jan Vachek ¹; Hana Ciferská ²; MUDr. PhDr. Oskar Zakiyanov, PhD. ¹; Vladimír Tesař ¹
Authors place of work: Klinika nefrologie 1. LF UK a VFN, Praha ¹; Revmatologický ústav, Praha ²
Published in the journal: Prakt Gyn 2015; 19(4): 234-237
Category: Perinatologie: Přehledový článek

Summary

Pregnancy and lactation in patients with pre-existing rheumatic disease may carry risk for the patients. Pregnancy has a huge impact on the musculoskeletal system and internal organs. Certain rheumatic diseases (e.g. rheumatoid arthritis) are normally not affected negatively by pregnancy. Other diseases including systemic lupus erythematosus may aggravate the course of the disease, with a tendency for more frequent flares of the disease and increased complications in the pregnancy. Drugs used in rheumatology appear to be at higher risk for the mother and foetus. The use of biologic agents becomes more common in these patients including pregnant women. At present use of biological agents throughout pregnancy in patients with severe disease is reserved to those that do not respond to immunosuppressive antirheumatic treatment. Specifically, the use of biological agents is advocated in diseases not properly treated according to the maternal or foetal compromise expected.

Key words:
pregnancy – rheumatic diseases – systemic lupus erythematosus – rheumatoid arthritis – glucocorticoids

Zdroje

1. Vachek J, Tesař V, Zakiyanov O et al. Farmakoterapie v těhotenství a při kojení. Maxdorf: Praha 2013. ISBN: 978–80–7345–333–6.

2. Bazzani C, Scrivo R, Andreoli L et al. Prospectively-followed pregnancies in patients with inflammatory arthritis taking biological drugs: an Italian multicentre study. Clin Exp Rheumatol 2015; 33(5): 688–693.

3. Vencovský J. Výbor České revmatologické společnosti. Bezpečnost biologické léčby – doporučení České revmatologické společnosti. Čes Revmatol 2009; 17(3): 146–160.

4. Murashima A, Watanabe N, Ozawa N et al. Etanercept during pregnancy and lactation in a patient with rheumatoid arthritis: drug levels in maternal serum, cord blood, breast milk and infant‘s serum. Ann Rheum Dis 2009; 68(11): 1793–1794.

5. Bortlik M et al. Pregnancy and newborn outcome of mothers with inflammatory bowel diseases exposed to anti-TNF-α therapy during pregnancy: three-center study. Scand J Gastroenterol. 2013; 4(8): 951–958.

6. Johnson DL, Jones KL, Chambers C. Pregnancy outcomes in women exposed to etanercept: The OTIS autoimmune diseases in pregnancy project (abstract). Arthritis Rheum 2008; 58(Suppl 9): S682.

7. Nielsen OH et al. Safety of TNF-α inhibitors during IBD pregnancy: a systematic review. BMC Med 2013; 11: 174. Dostupné z DOI: <http://doi:10.1186/1741–7015–11–174>.

8. Weber-Schoendorfer C, Oppermann M, Wacker E et al. Pregnancy outcome after TNF-α inhibitor therapy during the first trimester: a prospective multicentre cohort study. Br J Pharmacol 2015; 80(4): 727–739.