In the third edition of #rheumjc, author (and Twitter regular) John Cush MD discusses a report from a summit on management of pregnancy and lactation in women with autoimmune and inflammatory diseases.
The American College of Rheumatology ordered up a summit on fertility and pregnancy issues for patients with inflammatory and rheumatic diseases, and a group of experts responded.The proceedings, published last February in Arthritis Care and Research, were the topic of the latest Twitter-based journal club sponsored by @rheumjc, the rheumatology journal club on social media.On hand to discuss the high points was John Cush MD, director of rheumatology at the Baylor Research Institute and a consultant on many drug studies in rheumatology.In this brief slide show, Rheumatology Network again sorts, compiles, and presents the main topics of discussion.(Remember to look at the captions for hyperlinks to clinical articles or other resources mentioned in the slides.)
RheumJC Edition 3: Autoimmune Disease and Pregnancy summarizes a Twitter discussion of proceedings from a recent summit on the topic.
Kavanaugh A, Cush JJ, Ahmed MS et al., Proceedings From the American College of Rheumatology Reproductive Health Summit: The Management of Fertility, Pregnancy, and Lactation in Women With Autoimmune and Systemic Inflammatory Diseases.Arthritis Care & Research 2015;67:313-325 doi:10.1002/acr.22516
The publication discussed in #rheumjc edition 3: Kavanaugh A, Cush JJ, Ahmed MS et al., Proceedings From the American College of Rheumatology Reproductive Health Summit: The Management of Fertility, Pregnancy, and Lactation in Women With Autoimmune and Systemic Inflammatory Diseases.Arthritis Care & Research 2015;67:313-325 doi:10.1002/acr.22516
Recommended resources for patients:
"IBD and She", a video from the Crohn's foundation.
MotherRisk.org, a website published by the Hospital for Sick Children in Toronto.
Is medication risk a "black box" for pregnant women with rheumatic diseases? Not at all, says Dr. Cush. But his surveys show about one rheumatologist in 5 is uncomfortable with the use of TNF inhibitors during pregnancy, even though substantial data suggest they are safe.
It's important to know what drugs must be avoided during pregnancy, says Dr. Cush. High on the list: methotrexate, mycophenolate, cytotoxics, leflunomide. He lists others he would also avoid.
How long before conception should these drugs be withheld? There is some discussion of an extraordinary 2-year withdrawal period for leflunomide. Dr. Cush suggests an alternative.
At what point in the pregnancy should tumor necrosis inhibitors that cross the placenta be withheld? Dr. Cush suggests at 30 weeks, and offers further advice about vacdinations during pregnancy.
An Irish gastroenterologist weighs in with a recommendation to a useful resource:
2015 ECCO evidence-based consensus on reproduction and pregnancy in IBD