Table 5 Medication used during pregnancy
Drugs | Comments | Recommendations |
|---|---|---|
Non-steroidal anti-inflammatory drugs (NSAIDS) | First trimester use may be associated with higher risk of congenital malformations, foetal renal impairment and premature closure of ductus arteriosus with use in the last trimester | • Use with caution during the first and second trimester • Discontinue during last trimester |
Corticosteroids • Prednisolone/pulse methyl prednisolone • Flourinated compounds (betamethasone/dexamethasone) | • High doses can lead to higher maternal complications • Some association with impaired neuro-psychological development of the child | • Use the lowest possible dose Pulse therapy can be used for acute flares • Limit to one course, for foetal lung maturation |
Antimalarials • Hydroxychloroquine | Reduced risk of disease flares, CHB and NLS | Should be continued in all lupus pregnancies |
Immunosuppressants • Azathioprine • Calcineurin inhibitors (cyclosporine/tacrolimus) | Used in a large number of transplant recipients. Recent report of late developmental delays in offsprings with azathioprine | • Limit azathioprine dose to 2mg/kg/day • Explain the probability of late effects in the child to mother |
Anti-hypertensives • Methyldopa • Labetalol • Nifedipine • Hydralazine | Concerns about growth retardation with labetalol and impaired utero-placental blood flow with hydralazine | Generally safe and preferred drugs for hypertension during pregnancy |