[Treatment with immunosuppressive and biologic drugs of pregnant women with systemic rheumatic or autoimmune disease]

Med Clin (Barc). 2016 Oct 21;147(8):352-360. doi: 10.1016/j.medcli.2016.05.020. Epub 2016 Jul 5.
[Article in Spanish]


Rheumatic and systemic autoimmune diseases occur in women and, to a lesser degree, men of reproductive age. These disorders have to be clinically nonactive before conception, which is usually only possible after anti-inflammatory and immunosuppressive treatment. We must be alert since 50% of pregnancies are unplanned. Physicians should know the embryo-foetal toxicity of these drugs during pregnancy and lactation. This January 2016-updated review allows us to conclude that the majority of immunosuppressives available -anti-TNF inhibitors included- can be used before and during pregnancy, with the exception of cyclophosphamide, methotrexate, mycophenolate and leflunomide. Lactation is permitted with all drugs except methotrexate, leflunomide, mycophenolate and cyclophosphamide. Although data on abatacept, belimumab, rituximab, tocilizumab and anakinra are scant, preliminary reports agree on their safety during pregnancy and, probably, lactation. Cyclophosphamide and sulfasalazine apart, no negative effects on sperm quality, or embryo-foetal anomalies in men treated with immunosuppressives have been described.

Keywords: Adverse effects; Anti-TNF-α; Anti-inflammatory drugs; Antiinflammatorios; Autoimmune diseases; Biologics; Biológicos; Efectos adversos; Embarazo; Enfermedades autoinmunitarias; Immunosuppressive; Inmunodepresores; Lactancia; Lactation; Pregnancy.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Antirheumatic Agents / therapeutic use*
  • Autoimmune Diseases / drug therapy*
  • Breast Feeding
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Postnatal Care / methods
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Prenatal Care / methods
  • Rheumatic Diseases / drug therapy*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha