Table 3

Effects of medication in pregnancy

DrugKnown effects on fetusCurrent advice
High dose aspirin and NSAIDsPossible adverse effects on uterine contraction and platelet function.Avoid if possible—particularly final few weeks of pregnancy
Patent ductus arteriosus
HydroxychloroquineWithdrawal during pregnancy associated with flaresChloroquine but not hydroxychloroquine associated with congenital abnormalities and so best avoided
CorticosteroidsHigh doses associated with premature rupture of membranes, intra uterine growth retardation and maternal complications such as gestational diabetes, hypertension and avascular necrosis. No reports of teratogenicityIf possible avoid fluorinated corticosteroids such as dexamethasone and betamethasone which easily cross the placenta
AzathioprineTeratogenicity reported in animals. Sporadic cases such as preaxial polydactyl reported in humans. Most studies show that generally well toleratedBest avoided but may be considered if immunosuppression deemed necessary
CyclophosphamideTeratogenicity well established in humansAvoid during pregnancy. Effective contraception required during and for at least 3 months after discontinuation of treatment (includes males)
Mycophenolate mofetilToxicity seen in animal studiesAvoid during pregnancy. Effective contraception required during and for 6 weeks after discontinuation of treatment
Cyclosporin ANot an animal teratogen. Studies have confirmed relative safety in pregnancy. Long term effects uncertainMay be considered if immunosuppression deemed necessary