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Publication Detail
Biologic disease modifying anti-rheumatic drugs in pregnancy and breast-feeding period
  • Publication Type:
  • Authors:
    Nguyen H, Giles I
  • Publication date:
  • Pagination:
    377, 403
  • ISBN-13:
  • Status:
  • Book title:
    Biologics in Rheumatology: New Developments, Clinical Uses and Health Implication
Inflammatory rheumatic diseases (IRD) have a predilection for women of reproductive age, hence, many women with IRD have disease that has been controlled through treatment with standard and/or biologic disease modifying anti-rheumatic drugs (DMARDs) and are increasingly considering pregnancy. Historically, inflammatory rheumatic diseases such as rheumatoid arthritis (RA) were considered to spontaneously improve in most patients during pregnancy. Modern prospective studies however, have shown less than half of all patients with RA objectively improve during pregnancy and have a significant risk of disease flare post-partum. In addition, adverse pregnancy outcomes have been linked with increased disease activity in various IRD, such as RA and systemic lupus erythematosus (SLE). Therefore, adequate control of disease activity both immediately before, during and after pregnancy with medications that are compatible with pregnancy are essential, and the use of biologic (b)DMARDs to maintain disease control is increasingly being considered in pregnancy. There are however, potential concerns as to the safety of these drugs in pregnancy and breastfeeding because current reports on their use in this situation are limited to often inadvertent exposures described retrospectively in case reports/series or population registries. Adequately controlled studies with long term follow-up of infants exposed to these drugs in utero are lacking. Significantly, many bDMARDs have a similar structure to maternal IgG that can cross the placenta by active transport from 16 weeks of pregnancy onwards; hence many bDMARDs share this ability of placental transfer during organogenesis in pregnancy. In contrast, certain bDMARDs with different structures undergo appreciably less placental transfer. Therefore, knowledge of biologic structure is important when considering current evidence with regard to their potential effects upon pregnancy. The aim of this chapter is to summarise current information regarding structure, compatibility and use of various biologics for women with IRD at conception, during pregnancy, breastfeeding and consider their impact on longer term infant outcomes.
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